Chapter 16 - Ischemic Heart Disease

As a nurse working the emergency department, which of the following signs and symptoms are you concerned may indicate a patient is experiencing angina? Select all that apply. - Pain alleviated with nitrates - Muscle weakness - Pain radiating to the jaw and neck - Fever - Levine's sign

- levine's sign - pain radiating to the jaw and neck - pain alleviated with nitrates

Angina may be relieved by _________, which vasodilate(s) arteries. - nitroglycerin tablets - oxygen - sedatives - glucose tablets

- nitroglycerin tablets

Which of the following procedures will require the use of a healthy vein or artery to circumvent a coronary artery occlusion? - stent - CABG - PTCA - Angioplasty

- CABG

The physician requests that the cardiac biomarkers be tested over time. Which of the following is the expected pattern that may be present in Helen's samples? - Both cardiac troponin I and creatine phosphokinase myocardial band peak within 30 minutes of myocardial infarction. - Cardiac troponin I and creatine phosphokinase myocardial band will present with an inverse relationship. As one factor elevates, the other factor decreases. - Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain. - Cardiac biomarkers return to baseline within hours of the onset of chest pain.

- Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain.

A follow-up angiography shows an occlusion in the left anterior descending artery. Percutaneous coronary intervention (PCI) was used to restore perfusion. Which of the following likely occurred for Helen during PCI? - Drug-eluting stent placement - Thallium stress test - heart valve replacement - aortic dissection

- Drug-eluting stent placement

Because of the concern of myocardial infarction (MI), the physician orders an electrocardiogram (ECG), which reveals Helen has ST segment elevation. Which of the following statements are true? Select all that apply. - An ECG is the most definitive diagnostic test for an MI. - Helen's results indicate the presence of STEMI. - The ST segment elevation is a positive indicator for adequate perfusion of the heart. - Helen's ECG indicates the next appropriate step is for Helen to be sent home with instructions to rest and drink plenty of fluids. - The ECG results help explain why Helen was experiencing angina equivalents.

- Helen's results indicate the presence of STEMI. - The ECG results help explain why Helen was experiencing angina equivalents.

Helen is a 68-year-old woman who has been brought to the emergency department by her friend Karen. According to Karen, she and Helen had been working for several hours cleaning Helen's home. As they were finishing, Helen began to complain of heaviness in her chest, shortness of breath, and dizziness. These were not alleviated by Helen taking a nitroglycerin tablet and resting so Karen thought it best to bring Helen in for evaluation.As Helen experienced her symptoms, why may nitroglycerin tablets help? - Nitroglycerin is known to alleviate dizziness. - Nitroglycerin vasodilates arterioles helping with coronary blood flow. - Nitroglycerine tablets are antianxiety medications. - Nitroglycerin increases heart rate helping to maintain cardiac output.

- Nitroglycerin vasodilates arterioles helping with coronary blood flow.

Which of the following treatments utilizes a catheter with a balloon that is inflated to restore blood flow? - STEMI - NSTEMI - PTCA - CABG

- PTCA

Which test is most helpful in revealing the extent of damage to Helen's heart? - Echocardiogram - Coronary artery bypass grafting (CABG) - Venogram - Radionuclide myocardial perfusion imaging

- Radionuclide myocardial perfusion imaging

Of the following characteristics, which is associated with a STEMI? - Partial occlusion of coronary artery - Partial thickness damage of heart muscle -ST segment elevation - Relatively benign condition

- ST segment elevation

Which of the following statements about angina are true? Select all that apply. - Stable angina is considered a medical emergency. - Unstable angina may indicate new damage to the heart. - Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. - Increased oxygen levels and lactic acid formation may play a role in angina. - Unstable angina is chest pain the patient is experiencing for the first time.

- Unstable angina may indicate new damage to the heart - Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium - Unstable angina is chest pain the patient is experiencing for the first time

Given Helen's medical history, as well as her shortness of breath and feeling of dizziness, you believe she may be suffering from a myocardial infarction. The signs and symptoms of myocardial infarction may present differently in women. Which term applies to the signs and symptoms that may be present in a myocardial infarction that are not considered to be the typical presentation of chest pain? - Levine's sign - angina equivalents - intermittent leg claudication - cushing's triad

- angina equivalents

Factors that influence the amount of damage an MI causes include _______________. Select all that apply. - collateral circulation - gender - location - duration - age

- collateral circulation - location - duration

The physician also orders a blood test for Helen. Which factor supports a diagnosis of myocardial infarction? - Elevated LDL level - Elevated HDL level - Elevated Hct level - Elevated cardiac troponin 1

- elevated cardiac troponin 1

Myocardial infarction _________________________. Select all that apply. - usually resolves on its own, without any treatment. - is synonymous with myocardial ischemia. - results from increased oxygenation of heart tissue. - indicates death of heart tissue. - may produce abnormalities on an ECG.

- indicates death of heart tissue - may produce abnormalities on an ECG

Stable angina ___________. - is the chest pain experienced for the first time - is another name for a heart attack - is consistent, chronic chest pain - requires immediate surgical correction

- is consistent, chronic chest pain

Helen's vital signs show a heart rate of 82 bpm, BP of 118/78 mm Hg, respiratory rate of 28 breaths per minute, and oxygen saturation of 93%. At the current time, what medication options may be selected for Helen? She continues to complain of heaviness in her chest. Select all that apply. - oxygen - aspirin - IV nitrates - morphine - beta-adrenergic blockers

- oxygen - aspirin - IV nitrates - morphine - beta-adrenergic blockers

You are concerned that during Helen's treatment there may be further injury to myocardial cells by normalized oxygen levels. What is the term used for this type of injury? - Reentry injury - Repolarization injury - Angina equivalents - Reperfusion injury

- reperfusion injury

A patient is diagnosed with a STEMI in the emergency room. This means __________. - the patient is experiencing a minor injury to the heart - the patient is experiencing an aneurysm - the patient is experiencing complete occlusion of a coronary artery - the patient requires careful observation but not treatment at this time

- the patient is experiencing complete occlusion of a coronary artery