MI Complications Review Questions

A. -B is incorrect - the thrombus does not form in the lung itself - it traveled from a blood vessel or from the heart into the pulmonary artery. Thrombi do not form or travel from lung tissue into the pulmonary artery. Thrombi form where there is blood. -C is incorrect. A pulmonary embolism does not lodge in lung tissue, but rather the pulmonary artery or its branches.

How would you describe pulmonary embolism to another nursing colleague? A. A thrombus from somewhere else that is lodged in the pulmonary artery, obstructing blood flow through the pulmonary vasculature. B. A thrombus that formed in the lung and which obstructs the pulmonary vasculature. C. A thrombus of any origin (inside or outside the lung) that lodges in the lung tissue, obstructing the pulmonary vasculature.

B. Jugular vein distention in a patient with an inferior wall MI (the inferior wall is supplied by the RCA) indicates a pump failure of the right ventricle.

In which of the following disorders is jugular vein distention most prominent? A. Abdominal aortic aneurysm B. Left ventricular hypertrophy. C. Inferior wall MI. D. Hemothorax.

C - first action is to check the patient's pulse. Then, call code blue. Have a nursing colleague obtain the defibrillator and another colleague can call the attending physician.

Mr. Jones becomes unresponsive while the nurse is talking to him. The nurse's immediate action is to: A. Call the patient's attending physician. B. Activate code blue. C. Check the patient's pulse. D. Obtain the defibrillator.

D. Patients with anterior wall MI (the anterior wall overlies the LV) are most likely to develop severe CHF leading to cardiogenic shock. Given the history of CHF and location of infarct, these risk factors are most likely to cause cardiogenic shock.

Mr. Jones is a 58-year-old male with PMH of CHF, lung cancer (currently in remission), and HLD who is diagnosed with anterior wall infarction. Which combination of risk factors places him at highest risk for cardiogenic shock? A. His gender and history of CHF. B. His age and location of infarct. C. History of CHF and history of lung cancer. D. Anterior wall MI and history of CHF.

A. This acid-base imbalance occurs in cardiogenic shock because of the drop in cardiac output -> reduced perfusion to parts of the body/tissues far from the heart -> leads to lactic acid build-up in the tissues. This is called lactic acidosis. The brain communicates with the lungs, making the patient breathe faster to expel acid from the body (i.e. CO2), which will allow the bicarb to rise.

Mr. Jones' arterial blood gases are drawn. These are the results: pH 7.32, pCO2 30, bicarb 19, pO2 78. Based on these results, the nurse knows that the patient has: A. Metabolic acidosis, partially compensated. B. Metabolic alkalosis, partially compensated. C. Respiratory acidosis, uncompensated. D. Respiratory acidosis, partially compensated.

D. BUN and Creatinine are significantly elevated indicating renal failure. As cardiac output is reduced after myocardial infarction, the patient may have reduced perfusion to other organs, as well, such as the kidneys.

Mr. Reddy is a 73 y/o male who had myocardial infarction 24 hours ago. He has a urine output averaging 19 ml/hr for the last 2 hours. The patient received a single bolus of 500 ml of IV fluid. Urine output for the subsequent hour was 25 ml. Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL and the serum creatinine is 2.2 mg/dL. The nurse interprets that the client developed which complication of MI? A. Hypervolemia. B. UTI. C. Glomerulonephritis. D. Acute renal failure.

A & B -both Lisinopril and Metoprolol as they both lower BP (they're antihypertensive medications).

Mr. Reddy's BP is 90/50 mm Hg. The nurse knows that she needs to hold which medications? Select all that apply. A. Lisinopril. B. Metoprolol. C. Aspirin. D. Plavix.

D -the rhythm is ventricular tachycardia, which can deteriorate to ventricular fibrillation, a life threatening dysrhythmia. A is correct, but not the most concerning for the nurse. B and C are incorrect.

Mr. Reddy's telemetry rhythm is the following: The nurse is most concerned with this dysrhythmia because: A. It causes the patient to have a sensation of impending doom. B. It produces a high cardiac output, leading to cerebral and myocardial ischemia. C. It is almost impossible to convert to a normal sinus rhythm. D. It can develop into ventricular fibrillation at any time.

A. Lisinopril needs to be held as it can worsen renal function. Lisinopril blocks the effect of Angiotension II. Angiotension II causes vasoconstriction of efferent arterial (the blood vessel that exits the kidneys) which holds blood in the glomerulus for longer time and increases filtration rate of the glomerulus (GFR). Angiotension II also causes vasoconstriction of other arteries in the body, leading to an increase in BP.

Mr. Reddy, the patient who suffered an MI 24 hours ago is taking the following medications: Metoprolol, Lisinopril, Nitroglycerin, Aspirin and Plavix. Based on the patient's renal function labs (BUN 45 and Cr 2.2), the nurse knows that she needs to hold which medication? A. Lisinopril. B. Metoprolol. C. Aspirin. D. Plavix.

A. The papillary muscles are connected via the chordae tendinae to the mitral valve on the left side of the heart and to the tricuspid valve on the right side of the heart, thus they directly affect the function of the valves. Papillary muscle dysfunction will lead to regurgitant (aka leaky) valves causing blood to back-up. Eg. papillary muscle dysfunction on the left side of the heart, will not allow the mitral valve to fully close, leading to blood back-up from the LV to LA to pulmonary veins to lungs to pulmonary edema. Blood continues to back-up through the pulmonary artery to the right atrium and RV. Extra blood reaches the right side of the heart, now the RV has more blood to pump, so it has to pump more forcefully to eject extra blood. Eventually, the RV fails.

Papillary muscle dysfunction after myocardial infarction directly produces problems with: A. Valvular function. B. Left ventricle function. C. Right ventricle function. D. Interventricular septum.

D - cardiogenic shock. While all the others are true & they are all present in cardiogenic shock, cardiogenic shock most specifically describes the nurse's findings and has the greatest potential to be deadly.

The nurse finds Mr. Jones, the patient with anterior wall MI, looking pale. He is alert and complains of dizziness. The patient's current vital signs are the following: BP 88/45, HR 113, temp 36.4, SpO2 88%. Which is the nurse's greatest concern? A. He is hypotensive. B. He is hypoxemic. C. He developed heart failure. D. He is developing cardiogenic shock.

A. In cardiogenic shock, more than 40% of the heart's ability to pump is lost, so the goal is to improve perfusion (i.e blood flow).

The ultimate goal in the treatment of cardiogenic shock is to: A. Improve perfusion. B. Improve oxygen saturation. C. Improve hypercapnia. D. Improve tachycardia.

C. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Arrhythmias occur in about 80% of patients with MI: some are clinically insignificant like occasional premature ventricular contractions, and some can be life threatening like V-tach. -Option A: 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. -Option B: Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. -Option D: Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.

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

Consider Virchow's triad (hypercoagulability, venous stasis, blood vessel damage) when attempting to answer this question. Correct: A.Advanced age C.Contraceptive use D.Trauma to blood vessels F.Obesity G.Surgery H.Hypercoagulability I. Pneumonia K.Immobility

Which of the following are risk factors for Pulmonary Embolism? Select all that apply: A. Advanced age. B. Young age. C. Contraceptive use. D. Trauma to blood vessels. E. Underweight. F. Obesity. G. Surgery. H. Hypercoagulability. I. Pneumonia J. Immobility.

C A high Fowler's position promotes ventilation and facilitates breathing by reducing venous return -Options A and B: Lying flat or on the side-lying positions do not help the patient with SOB and increase the workload of the heart. In acute pulmonary edema, the patient has significant SOB -Option D: Semi-Fowler's position won't reduce the workload of the heart as well as the high Fowler's position will.

Which of the following positions would best aid breathing for a client with acute pulmonary edema? A. Lying flat in bed. B. Left side-lying. C. In high Fowler's position. D. In semi-Fowler's position.

C. Patients with cardiogenic shock develop metabolic acidosis, so the lactic acid will be elevated and will confirm the acidosis.

Which of these diagnostic tests are best during the immediate management of cardiogenic shock? A. CT scan of the heart. B. Echocardiogram. C. Lactic acid levels. D. Chest x-ray.

A. If the ventricle is dilated, it will overfill with blood-hence the S3 sound (sloshing in!)

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

D. Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak & thready pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.

A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient with cardiogenic shock to exhibit initially? A. Hypertension. B. Bradycardia. C. Bounding pulse. D. Confusion.

B - lower extremity thrombi can embolize to the pulmonary vasculature.

A patient diagnosed with pulmonary embolism has venous ultrasound of lower extremities ordered. The purpose of this is: A. To evaluate venous circulation. B. To detect lower extremity thrombi. C. To check for venous insufficiency. D. To check the function of the valves in venous circulation.

A. Left-sided heart failure The left ventricle (LV) is responsible for most of the cardiac output. The anterior wall of the heart overlies the LV, thus an MI of the anterior wall can result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid backs up from the LV LAPulmonary veins lungs. The fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Options B, C, and D are incorrect: Pulmonic and tricuspid valve malfunction cause right-sided heart failure.

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.