Ischemic Heart Disease
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
A patient has suffered a myocardial infarction. Which factors are expected to be elevated? Select all that apply. Cardiac troponin Hematocrit (Hct) Aspartate aminotransferase (AST) Creatine phosphokinase-myocardial band High-density lipoprotein (HDL)
Cardiac troponin Creatine phosphokinase-myocardial band
A student nurse is reviewing electrocardiograms (ECGs). Which of the following does she recognize as true about ECGs and myocardial infarctions (MIs)? ECGs alone are not diagnostic for MIs. With MIs, P-R elevation is expected. Most MIs are preceded by development of prolonged P-R intervals. Most MIs show no changes on ECG.
ECGs alone are not diagnostic for MIs.
Factors that influence the amount of damage an MI causes include _____________. Select all that apply. collateral circulation gender location duration age
location collateral circulation duration
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 Angina equivalents are signs and symptoms associated with a myocardial infarction that differ from the typical angina pectoris presentation. Levine's sign is when a patient suffering from a myocardial infarction places his or her fist over the sternal area. Intermittent leg claudication and Cushing's triad are not associated with myocardial infarctions.
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. Cardiac troponin I level rises within 4 to 8 hours of onset of chest pain. The cardiac biomarkers do not return to baseline levels for several days. The cardiac biomarkers do not have an inverse relationship; rather, with damage of myocardial cells, both cardiac biomarkers increase in the serum.
Please place in the proper order how atherosclerosis may lead to a myocardial infarction. Coronary artery occlusion Decreased myocardial oxygen delivery Decreased myocardial blood flow Myocardial ischemia Myocardial infarction
Coronary artery occlusion Decreased myocardial blood flow Decreased myocardial oxygen delivery Myocardial ischemia Myocardial infarction
Which of the following should be on a chart that describes anginal equivalents, especially in women? Select all that apply. Dizziness Crushing chest pain Episodic dyspnea Pain in back Levine's sign
Dizziness Episodic dyspnea Pain in back
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 A drug-eluting stent may be placed in the coronary artery to restore perfusion. Heart valve replacement is not considered during an MI. Thrombolytics rather than administration of clotting factors would be a treatment for myocardial infarction.
The physician also orders a blood test for Helen. Which factor supports a diagnosis of myocardial infarction? Elevated LDL levels Elevated HDL levels Elevated Hct levels Elevated cardiac troponin I
Elevated cardiac troponin I Cardiac troponin I is a factor released from cardiac cells undergoing necrosis. This factor elevates in the blood after myocardial infarction and is considered to be the preferred biomarker for myocardial infarction. Creatine phosphokinase myocardial band is another cardiac marker; however, the absence of this factor in the blood would indicate an MI is likely not occurring. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and hematocrit (Hct) levels are not indicative of MI. Next
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. An ECG is not the diagnostic test for MI, although it may provide important clinical information. The ST segment elevation indicates that Helen is likely experiencing a STEMI (ST segment elevation MI), causing complete occlusion of a coronary artery. The arterial occlusion would explain why Helen was experiencing angina equivalents.
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
Muscle weakness Pain radiating to the jaw and neck Levine's sign
Which of the following terms indicates the most severe coronary event? Partial coronary artery occlusion Myocardial infarction Myocardial ischemia Myocardial apoptosis
Myocardial infarction
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. Nitroglycerin vasodilates arterioles, helping to maintain blood flow to coronary tissue and alleviating 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 All of the listed options can be used to manage myocardial infarctions. Oxygen is given if saturation levels are less than 95%, aspirin reduces platelet aggregation, and nitrates and morphine may be used to alleviate pain. Beta blockers reduce the workload on the heart.
Which of the following treatments utilizes a catheter with a balloon that is inflated to restore blood flow? STEMI NSTEMI PTCA CABG
PTCA
A nursing student is working on the difference between NSTEMI and STEMI. Which of the following is associated with NSTEM? S-T segment elevation Partial coronary artery occlusion Transmural damage Complete coronary artery occlusion
Partial coronary artery occlusion
A nurse is told to look for Levine's sign. Which of the following should she look for? Patient with vertigo Patient with tense jaw Patient with fist over sternum Patient with pain radiating down arm
Patient with fist over sternum
A nurse is using this figure as a teaching aid. Which condition is she showing? Pericardial effusion Pericarditis Papillary muscle rupture Pleuritis
Pericardial effusion
To reduce the risk of a coronary event, a patient informs the nurse that he is taking an aspirin daily. By taking this aspirin, which of the following processes are altered? Blood vessel dilation Coagulation factor synthesis Fibrinolysis Platelet adherence
Platelet adherence
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 Radionuclide myocardial perfusion imaging involves injecting a radionuclide dye into the bloodstream to highlight areas of the heart lacking perfusion. An echocardiogram cannot differentiate an acute MI from an old one, and a venogram examines the veins, not the coronary arteries.
A nursing educator is discussing with a nursing student that damaged heart muscle is susceptible to further injury by rapid, high-oxygenation issues. The nursing student states that she has heard of this development before. Which of the following terms is the nursing student referring to? Reentry circuits Repolarization disturbances Reperfusion injuries Recalibration injuries
Reperfusion injuries
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 injuries occur because damaged myocardial cells poorly tolerate normalized levels of oxygen.
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
A nurse hears that a patient has a ST-elevation myocardial infarction (STEMI) with elevated cardiac serum markers. Which of the following is a correct interpretation of this information? The patient has a severe, systemic infection. The patient is experiencing a mild coronary occlusion. The patient is experiencing mild angina. The patient is experiencing a myocardial infarction (MI).
The patient is experiencing a myocardial infarction (MI).
A woman is reviewing her father's medication list and comes across nitroglycerin tablets. She asks about the purpose of the tablets. Which of the following is an appropriate response by the nurse? The tablet help with your father's dizziness. The tablets help with the workload on the heart. The tablets can help relieve chest pain. The tablets help your father breathe easier.
The tablets can help relieve chest pain.
Which of the following statements by a patient may indicate unstable angina? My chest pain feels like it always does. I took a nitroglycerin tablet and now feel better. This pain is like nothing I have ever felt before. When I laid down for a few moments, I felt better.
This pain is like nothing I have ever felt before.
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.
A patient is to receive a quadruple coronary artery bypass graft. What is the result of the procedure? Create a bypass around the four chambers of the heart. Reconnect vessels to connect the heart chambers differently. Use harvested vessels to circumvent four arterial blockages. Place four stents in the heart arteries.
Use harvested vessels to circumvent four arterial blockages.
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 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.
Angina may be relieved by ______________, which vasodilate(s) arterioles. nitroglycerin tablets oxygen sedatives glucose tablets
nitroglycerin tablets
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 no treatment at this time.
the patient is experiencing complete occlusion of a coronary artery.
