PrepU Query Quiz: Perfusion: MI
A client with chronic bronchitis asks the nurse about why it's important to exercise. What would be the nurse's best response? A: "It enhances cardiovascular fitness." B: "It improves respiratory muscle strength." C: "It reduces the number of acute attacks." D: "It worsens respiratory function and is discouraged."
A: "It enhances cardiovascular fitness." Explanation: Exercise can improve cardiovascular fitness and it helps the client to better tolerate periods of hypoxia, perhaps reducing the risk of heart attack. Most exercise has little effect on respiratory muscle strength, and these clients can't tolerate the type of exercise necessary to do this. Exercise won't reduce the number of acute attacks. In some instances, exercise may be contraindicated. The client should check with his health care provider before starting any exercise program.
A 48-year-old client with challenging menopausal symptoms is visiting the OB-GYN practice where you practice nursing. She has discussed treatment options with the physician and now has some questions that she would like to further discuss with you. The client includes in her questioning, "What are the potential risks of hormone replacement therapy?" Which of the following is the best answer? A: All options are correct. B: Breast cancer C: Stroke (CVA) D: Heart disease
A: All options are correct. Explanation: In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in blood clots and stroke in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in heart disease in postmenopausal women taking HRT.
A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: A: Elevated troponin levels B: Decreased LDH levels C: Decreased myoglobin levels D: Increased C-reactive protein levels
A: Elevated troponin levels Explanation: Troponin is present only in myocardial tissue; therefore, it is the gold standard for determining heart damage in the early stages of an MI. LDH1 and LDH2 may be elevated in response to cardiac or other organ damage during an MI. Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage during an MI. C-reactive protein, erythrocyte sedimentation rate, and the WBC count increase on about the third day following MI because of the inflammatory response that the injured myocardial cells triggered. These levels would not be elevated during the MI event.
A female patient is being seen in the ER complaining of fatigue and shoulder blade discomfort. She is also short of breath. Based on these symptoms, the nurse should suspect which of the following? A: Myocardial infarction (MI) B: Deep vein thrombosis (DVT) C: Stroke D: Intracerebral hemorrhage
A: Myocardial infarction (MI) Explanation: Women often present with symptoms different from those seen in men, therefore a high level of suspicion is associated with vague complaints such as fatigue, shoulder blade discomfort, and/or shortness of breath. The clinical manifestations noted are not consistent with DVT, stroke, or intracerebral hemorrhage.
The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse? A: ST elevations B: Isolated premature ventricular contractions (PVCs) C: Sinus tachycardia D: Frequent premature atrial contractions (PACs)
A: ST elevations Explanation: The first signs of an acute MI are usually seen in the T wave and ST segment. The T wave becomes inverted; the ST segment elevates (usually flat). An elevation in ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e. ST elevation myocardial infarction, STEMI). This patient requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.
The client was admitted to the hospital following a myocardial infarction. Two days later, the client exhibits a blood pressure of 90/58, pulse rate of 132 beats/min, respirations of 32 breaths/min, temperature of 101.8°F, and skin warm and flushed. Appropriate interventions include (Select all that apply) A: obtaining a urine specimen for culture B: maintaining the IV site inserted on admission C: instituting vital signs every 4 hours D: administering pantoprazole (Protonix) IV daily E: monitoring urine output every hour
A: obtaining a urine specimen for culture D: administering pantoprazole (Protonix) IV daily E: monitoring urine output every hour Explanation: The client is exhibiting signs of septic shock. It is important to identify the source of infection, such as obtaining a urine specimen for culture. Medication, such as pantoprazole, would be administered to prevent stress ulcers. The nurse would monitor urinary output every hour to evaluate effectiveness of therapy. IV sites would be changed and catheter tips cultured as this could be the source of infection. The client's condition warrants vital signs being assessed more frequently than every 4 hours.
Nurse Progress Notes 1300 BP: 110/70 T: 98.7 HR: 70 R: 20 Urine output: 90mL/h 1500 BP: 100/65 T: 99 HR: 75 R: 26 Urine output: 20mL/h ------------------------------------------- The nurse is monitoring a client admitted with a myocardial infarction (MI) who is at risk for cardiogenic shock. The nurse should report which change on the client's chart to the health care provider (HCP)? A: urine output B: heart rate C: blood pressure D: respiratory rate
A: urine output Explanation: Oliguria occurs during cardiogenic shock because there is reduced blood flow to the kidneys. Typical signs of cardiogenic shock include low blood pressure, rapid and weak pulse, decreased urine output, and signs of diminished blood flow to the brain, such as confusion and restlessness. Cardiogenic shock is a serious complication of MI, with a mortality rate approaching 90%. Fever is not a typical sign of cardiogenic shock. The other changes in vital signs on the client's chart are not as significant as the decreased urinary output.
When the nurse is obtaining a health history on an elderly client who has had a previous myocardial infarction, the daughter states, "I have been giving my father ginkgo biloba every day, as he is beginning to have some memory loss." How does the nurse respond to the daughter's statement? A: "Stop giving your father the herbal drug immediately." B: "How much of the herbal drug are you giving your father every day?" C: "Did you ask your health care provider before giving him the herbal drug?" D: "This may interfere with other medications your father is taking."
B "How much of the herbal drug are you giving your father every day?" Explanation: The nurse's response should be "How much of the herbal drug are you giving your father every day?" Using the nursing process, always assess the situation first.
A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect? A: "I have a bad headache." B: "My chest pain is decreasing." C: "I feel a tingling sensation around my mouth." D: "My vision is blurred, so my blood pressure must be up."
B: "My chest pain is decreasing." Explanation: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium. This action produces the drug's intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication? A: Atherosclerosis B: Angina pectoris C: Atheroma D: Ischemia
B: Angina pectoris Explanation: Angina pectoris is a symptom of myocardial ischemia. Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens. Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial vessels. Ischemia is insufficient tissue oxygenation and may occur in any part of the body.
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? A: Chest pain is typical B: Vague symptoms C: Decreased sensation to pain D: Gender bias
B: Vague Symptoms Explanation: Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.
Nurse Progress Notes Date: 1/10 Time: 0030 Urinary output for the last 4 hours: 90mL Cap refill: >3 seconds BP: 128/82 Extremities: Cool ----------------------------------------------- An older adult had a myocardial infarction (MI) 4 days ago. At 0930, the client's blood pressure is 102/64 mm Hg. After reviewing the client's progress notes (see chart), the nurse should first: A: give a fluid challenge/bolus. B: notify the health care provider (HCP). C: assist the client to walk. D: administer furosemide as prescribed.
B: notify the health care provider (HCP). Explanation: All of the 1200 hour assessments are signs of decreased cardiac output and can be an ominous sign in a client who has recently experienced an MI; the nurse should notify the HCP of these changes. Cardiac output and blood pressure may continue to fall to dangerous levels, which can induce further coronary ischemia and extension of the infarct. While the client is currently hypotensive, giving a fluid challenge/bolus can precipitate increased workload on a damaged heart and extend the myocardial infarction. Exercise or walking for this client will increase both the heart rate and stroke volume, both of which will increase cardiac output, but the increased cardiac output will increase oxygen needs especially in the heart muscle and can induce further coronary ischemia and extension of the infarct. The client is hypotensive. Although the client has decreased urinary output, this is the body's response to a decreasing cardiac output, and it is not appropriate to administer furosemide.
Nurse Progress Notes Lab Report Test: Cholesterol total: Result: 195 (5.05) Units: mg/dL (mmol/L) Reference Range: <200 (<5.18) Triglycerides: Result: 106 (1.20) Units: mg/dL (mmol/L) Reference Range: <150 (<1.69) HDL-cholesterol: Result: 69 (1.79) Units: mg/dL (mmol/L) Reference Range: >39 (<1.03) ----------------------------------------------- The nurse is preparing a teaching plan for a client who is being discharged after being admitted for chest pain. The client has had one previous myocardial infarction 2 years ago and has been taking simvastatin 40 mg for the last 2 years. After reviewing the lab results for the client's cholesterol levels (see chart), the nurse should: A: ask if the client is taking the simvastatin regularly. B: tell the client that the cholesterol levels are within normal limits. C: instruct the client to lower the saturated fat in the diet. D: review the chart for lab reports of hemoglobin and hematocrit.
B: tell the client that the cholesterol levels are within normal limits. Explanation: The serum cholesterol is within normal range for this client indicating the medication is effective. Since the cholesterol levels are within normal limits, it is likely that the client is taking the medication and asking may indicate the nurse has doubts or mistrusts that the client is taking the medication. The client does not need to change the diet at this point. Hemoglobin and hematocrit are not affected by simvastatin; since liver damage is a side effect of simvastatin, the nurse could review the liver function studies.
In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? A: 30 minutes B: 9 days C: 60 minutes D: 6 to 12 months
C: 60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.
A physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the previous 6 months. Which action should the nurse take? A: Administer the medication as ordered. B: Discontinue the medication. C: Question the physician about the order. D: Inform the client that he should discuss his MI with the physician.
C: Question the physician about the order. Explanation: Cardiovascular toxicity is a problem with tricyclic antidepressants, and the nurse should question the use of these drugs in a client with cardiac disease. Administering the medication would be an act of negligence. A nurse can't discontinue a medication without a physician's order. It's the nurse's responsibility, not the client's, to discuss questions of care with the physician.
The nurse is developing a discharge plan for a client who has had a myocardial infarction. Planning for discharge for this client should begin: A: on discharge from the hospital. B: on discharge from the cardiac care unit. C: on admission to the hospital. D: four weeks after the onset of illness.
C: on admission to the hospital. Explanation: A basic principle of rehabilitation, including cardiac rehabilitation, is that rehabilitation begins on hospital admission. Early rehabilitation is essential to promote maximum functional ability as the client recovers from an illness. Delaying rehabilitation activities is associated with poorer client outcomes.
Which activity would be appropriate to delegate to unlicensed assistive personnel (UAP) for a client diagnosed with a myocardial infarction who is stable? A: Evaluate the lung sounds. B: Help the client identify risk factors for CAD. C: Provide teaching on a 2-g sodium diet. D: Record the intake and output.
D: Record the intake and output. Explanation: UAP are able to measure and record intake and output. The nurse is responsible for client teaching, physical assessments, and evaluating the information collected on the client.
A client has chest pain rated at 8 on a 10-point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and troponin levels are elevated. What should the nurse do first? A: Monitor daily weights and urine output. B: Limit visitation by family and friends. C: Provide client education on medications and diet. D: Reduce pain and myocardial oxygen demand.
D: Reduce pain and myocardial oxygen demand. Explanation: Nursing management for a client with a myocardial infarction should focus on pain management and decreasing myocardial oxygen demand. Fluid status should be closely monitored. Client education should begin once the client is stable and amenable to teaching. Visitation should be based on client comfort and maintaining a calm environment.
The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac rhythm shown. The nurse identifies that this rhythm is: A: atrial fibrillation. B: ventricular tachycardia. C: premature ventricular contractions. D: third-degree heart block.
D: third-degree heart block. Explanation: Third-degree heart block occurs when atrial stimuli are blocked at the atrioventricular junction. Impulses from the atria and ventricles are conducted independently of each other. The atrial rate is 60 to 100 bpm; the ventricular rate is usually 10 to 60 bpm.
A couple have presented to the healthcare provider for a follow up visit following the husbands myocardial infarction (MI) one week ago. The nurse knows that education on resuming intimate sexual contact should be discussed. Which of the following is correct regarding the timeline for returning to sexual intercourse? A: one week if no symptoms of chest pain B: three weeks if no symptoms of chest pain C: one month if no symptoms of chest pain D: three months if no symptoms of chest pain
D: three months if no symptoms of chest pain Explanation: Activities of daily living, including sexual activity, should be resumed gradually, and stressors such as overexertion, alcohol consumption, and emotional upheavals should be avoided. After an uncomplicated MI, sexual activity may begin at about the third week of recovery, beginning with masturbation to partial erection in the male. Generally, this activity is gradually increased until 3 months after the MI, when sexual intercourse may be resumed. Any chest pain that occurs should be discussed with the healthcare provider prior to resuming sexual intercourse.
The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse, and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? All options must be used. 1 Position electrodes on the chest. 2 Take vital signs. 3 Administer the prescribed dose of morphine. 4 Obtain a history of which drugs the client has used recently.
Position electrodes on the chest. Take vital signs. Administer the prescribed dose of morphine. Obtain a history of which drugs the client has used recently. Explanation: The nurse should first connect the client to the monitor by attaching the electrodes. Electrocardiography can be used to identify myocardial ischemia and infarction, rhythm and conduction disturbances, chamber enlargement, electrolyte imbalances, and the effects of drugs on the client's heart. The nurse next obtains vital signs to establish a baseline. Next, the nurse should administer the morphine; morphine is the drug of choice in relieving myocardial infarction (MI) pain; it may cause a transient decrease in blood pressure. When the client is stable, the nurse can obtain a history of the client's drug use.
A client recovering from a myocardial infarction asks why he needs to take a stool softener. He says, "I had a heart attack; I don't have a problem with constipation." Which explanation should the nurse use to answer the client's question? A: "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous." B: "Your doctor ordered this stool softener for you." C: "Everyone who has a heart attack takes stool softeners." D: "Hospital food causes constipation."
A: "If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous." Explanation: When straining during defication, the client bears down, which momentarily may cause the heart to slow and cause fainting or syncope in the client.
A 62-year-old female who is 2 weeks CABG returns to her cardiologist due to new symptoms, including heaviness in her chest and pain between her breasts. She reports that leaning forward decreases the pain. The cardiologist admits her to the hospital to rule out pericarditis. Which of the following is a contributing cause to pericarditis? Select all that apply. A: Cardiac surgery B: Pneumonia C: Tuberculosis D: Myocarditis E: Chest trauma
A: Cardiac surgery C: Tuberculosis D: Myocarditis E: Chest trauma Explanation: Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack) or develops after cardiac surgery.
The client has been managing angina episodes with nitroglycerin. Which finding indicates that the therapeutic effect of the drug has been achieved? A: decreased chest pain B: increased blood pressure C: decreased blood pressure D: decreased heart rate
A: decreased chest pain Explanation: Nitroglycerin acts to decrease myocardial oxygen consumption. Vasodilation makes it easier for the heart to eject blood, resulting in decreased oxygen needs. Decreased oxygen demand reduces pain caused by heart muscle not receiving sufficient oxygen. While blood pressure may decrease ever so slightly due to the vasodilation effects of nitroglycerine, it is only secondary and not related to the angina the client is experiencing. Increased blood pressure would mean the heart would work harder, increasing oxygen demand and thus angina. Decreased heart rate is not an effect of nitroglycerine.
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? A: "When I finish the rehabilitation program I'll never have to worry about heart trouble again." B: "I won't be able to jog again even with rehabilitation." C: "Rehabilitation will help me function as well as I physically can." D: "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."
C: "Rehabilitation will help me function as well as I physically can." Explanation: The client demonstrates understanding of cardiac rehabilitation when he states that it helps the client reach his activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education.
