NUR336 Evolve: Pathophysiology of Acute Coronary Syndromes - TTC 9/26
A patient with a history of stable angina presents to the ER with unstable angina. The nurse explains the difference between stable and unstable angina. What statement by the patient demonstrates the need for further teaching?
"Unstable angina usually only happens when you exercise."
A primary health care provider conducted a yearly cardiac screening program. What questions should the nurse ask to select the individuals for this program?
-"Do you have diabetes?" -"Do you have hypertension?" -"Do you drink and smoke daily?"
In a health fair, which individuals would be ideal candidates for cardiac screening?
-A person with a post-menopausal history. -A person with a body mass index of 30 kg/msquared. -A person with a family history of heart disease.
What non-modifiable risk factors for atherosclerosis should a patient be assessed for?
-Age. -Ethnic background.
What electrolytes are most important to evaluate in a patient diagnosed with a myocardial infarction?
-Calcium. -Potassium. -Magnesium.
What modifiable risk factors should be included in education for a patient at risk for development of atherosclerosis?
-Chewing tobacco use. -Decreased coping skills. -Elevated serum lipids levels.
The nurse is caring for a patient with a non-ST elevated myocardial infarction. What are the causes of this diagnosis?
-Coronary vasospasm. -Spontaneous dissection. -Narrowing of the coronary artery.
What complications can occur as a result of ventricular remodeling?
-Heart failure. -Chronic ventricular dysrhythmias. -Decreased left ventricular function.
What factors increase oxygen requirements in a patient experiencing a myocardial infarction?
-Increase in after load. -Increase in contractility. -Release of catecholamine.
Which characteristics place women at high risk for myocardial infarction (MI)?
-Increasing age. -Family history. -Abdominal obesity.
Which signs/symptoms does the nurse expect to assess in a patient diagnosed with cardiogenic shock?
-Oliguria. -Change in mental status. -Low mean arterial blood pressure.
What actions result from the rupture of atherosclerotic plaque in the coronary artery?
-Platelet aggregation. -Thrombus formation.
Which disorders are forms of acute myocardial infarction?
-ST elevation. -Non-ST elevation. -Unstable angina pectoris.
What electrocardiographic changes are associated with myocardial infarction?
-ST elevation. -T wave inversion. -Abnormal Q wave.
Which structures are supplied blood by the right coronary artery (RAC)?
-Sinoatrial node. -Atrioventricular node. -Inferior wall of the left ventricle.
What findings are consistent with a patient diagnosed with obstruction of the circumflex artery?
-Sinus dysrhythmias. -Lateral wall myocardial infarction. -Posterior wall myocardial infarction.
What components of the patient's cardiac rhythm should be evaluated when determining the location and damage after a myocardial infarction?
-T wave. -Q wave. -ST segment.
The nurse is providing discharge instructions to a patient who has experienced a myocardial infarction. What teaching should be included?
-The need to decrease stress. -Information on smoking cessation.
What factors are associated with the extent of the zone of infarction?
-Workload demands. -Collateral circulation. -Anaerobic metabolism.
How long after a myocardial infarction does the necrotic area begin to develop into a firm scar?
2 to 3 months.
What change on the electrocardiogram is associated with the zone of necrosis in a patient experiencing a myocardial infarction?
Abnormal Q wave.
A patient diagnosed with a myocardial infarction has developed orthopnea, shortness of breath, and crackles in the lungs. What type of myocardial infarction does the nurse suspect?
Anterior wall.
The nurse is caring for a group of patients who have sustained myocardial infarction (MI). The nurse observes the patient with which type of MI most carefully for the development of left ventricular heart failure?
Anterior wall.
The patient diagnosed with myocardial infarction has an elevated ST segment on the electrocardiogram. What does this change represent?
Area of injury.
A patient diagnosed with my myocardial infarction has the following labs: potassium 3.5 mEq/L, calcium 7.5 mg/dL, magnesium 1.8 mEq/L, and pH 7.43. What value should be reported to the health care provider first?
Calcium 7.5 mg/dL.
A patient diagnosed with myocardial infarction has developed a sinus dysrhythmia. What artery does the nurse expect the obstruction to be occurring in?
Circumflex artery.
A patient with hypertension reports chest pain. The primary health care provider advises a right-sided electrocardiogram (ECG) after observing the regular ECG. What could be this patient's possible diagnosis?
Inferior wall myocardial infarction.
A patient diagnosed with a myocardial infarction has a T wave inversion on the electrocardiogram. What does this change represent?
Ischemia.
Which fact about unstable angina is correct?
It may occur at rest or with activity.
Which structure is supplied blood by the circumflex artery?
Lateral wall of the left ventricle.
A patient diagnosed with myocardial infarction has the following labs: potassium 3.5 mEq/L, calcium 8.5 mg/dL, magnesium 1.0 mEq/L, and pH 7.36. What value should be reported to the health care provider first?
Magnesium 1.0 mEq/L.
A patient with a history of angina presents to the emergency department with a new onset of chest pain. The ECG shows an elevation of the ST segment. The patient's troponin level is negative, and the creatine kinase (CK) is slightly elevated. What diagnosis are the symptoms consistent with?
Myocardial infarction (MI).
A patient diagnosed with a myocardial infarction has an abnormal Q wave present on the electrocardiogram. What does this change represent?
Necrosis.
When comparing a 12-lead electrocardiogram to one from one month ago, the nurse notes changes in the Q wave. What does this finding indicate?
Necrosis.
A patient reports to the emergency department after developing chest pain while shoveling. The pain is relieved with 2 sublingual nitroglycerin tabs. There are no changes in the patient's ECG and the cardiac enzymes are not elevated. What diagnosis is consistent with these findings?
New onset angina.
What finding is consistent with myocardial infarction in women?
Non-ST elevation on an ECG.
A patient is diagnosed with unstable angina. When comparing the 12-lead ECG to a previous 12-lead ECG, the nurse notices changes in the ST segment. What should the nurse do first?
Notify the health care provider.
Which is a modifiable risk factor for coronary artery disease?
Obesity.
A patient presents to the emergency department after sudden onset of chest pain, which began after waking up. The pain was not relieved with sublingual nitroglycerin. What intervention is priority?
Obtain a 12-lead ECG.
Which patient is suffering from myocardial infarction (MI)?
Patient with ST elevation.
A patient diagnosed with myocardial infarction has the following labs: potassium 2.9 mEq/L, calcium 8.5 mg/dL, magnesium 1.8 mEq/L, and pH 7.39. What value should be reported to the health care provider first?
Potassium 2.9 mEq/L.
A patient is admitted to the emergency department with chest pain. The patient has normal cardiac enzymes and no ST elevation. What action by the nurse is priority?
Repeat the cardiac enzymes test in 3 hours.
A patient is experiencing an ST elevation myocardial infarction with 100% occlusion to the coronary artery. What medical intervention does the nurse expect the patient to require?
Revascularization.
A patient is suspected of having an inferior wall myocardial infarction. What test is priority?
Right-sided electrocardiogram.
What finding is consistent with a rupture of the fibrous atherosclerotic plaque that has led to platelet aggregation and thrombus formation?
ST elevation in two leads on a 12-lead ECG.
What area on an electrocardiogram represents an injured tissue that is not necrotic?
ST elevation.
What change on the electrocardiogram is associated with the zone of injury in a patient experiencing a myocardial infarction?
ST elevation. ST elevation associated and seen on EKG of patient experiencing myocardial infarction.
The nurse is caring for a patient diagnosed with a 55% blockage of the coronary arteries. What should the nurse monitor the patient for?
Shortness of breath.
A 55-year-old patient with a history of smoking for the past 30 years reports chest discomfort upon prolonged exertion and has a slight limitation in his activity level. Which could be this patient's diagnosis?
Stable angina.
The nurse is providing care to a patient during an annual health maintenance visit. The patient's assessment findings include: waist size- 42 inches, BP- 140/90 mm Hg, high-density lipoprotein (HDL) - 30 mg/dL, triglycerides- 160 mg/dL, fasting glucose- 110 mg/dL. The nurse suspects that the patient is experiencing what?
Syndrome X.
What area of the electrocardiogram demonstrates tissue that is oxygen-deprived but not injured or necrotic?
T wave inversion.
What electrocardiographic change would represent ischemia?
T wave inversion.
The patient presents to the emergency department with severe chest pain while at rest. The patient has changes on the electrocardiogram (ECG) but has negative troponin and creatine kinase levels. What diagnosis are these symptoms consistent with?
Unstable angina.
A patient with hypertension reports chest pain typically after rest. What could be the possible diagnosis?
Variant angina.
The nurse is documenting the assessment of a patient with coronary artery spasms. What term is used to document chest pain the patient experiences after resting?
Variant angina.
A patient diagnosed with myocardial infarction has the following labs: potassium 3.5 mEq/L, calcium 8.5 mg/dL, magnesium 1.8 mEq/L, and pH 7.31. What value should be reported to the health care provider first?
pH 7.31.
