Acute Coronary Syndromes
What is the order in which blood passes through the four heart valves in sequential order.
"Toilet Paper My Ass" T-Tricuspid P-Pulmonic M-Mitral A-Aortic
The nurse is admitting a client who states, "When I was pregnant I would get heartburn so bad, I was eating antacids like crazy. I now feel the same way, except I am not pregnant. The antacids aren't helping me and now I have this pain between my shoulder blades." Which part of this statement is mostconcerning and must be investigated further? "When I was pregnant I would get heartburn so bad" "The antacids aren't helping me" "I have this pain between my shoulder blades" "I was eating antacids like crazy"
"I have this pain between my shoulder blades" This female client is showing signs of a myocardial infarction. Women often present with atypical symptoms and will often describe a feeling of acid reflux that is actually a heart attack. This client needs an EKG (ECG) immediately to rule out a STEMI.
The nurse is helping to manage a client who has suffered an acute MI. Which of the following laboratory findings does the nurse expect to find following this event? Select all that apply. A. Elevated CKMB B. Negative substance P C. Negative troponins D. Elevated Myoglobin E. Negative CK isoforms
A & D. Findings in an acute MI an elevated CKMB band level, elevated troponins, elevated myoglobin, and elevated CK Isoforms.
A 56-year-old client is being seen at the primary care clinic for follow-up after having chest pain. The client tells the nurse, "I think I had a heart attack yesterday but it could have just been chest pain. It still hurts some, though." The provider orders a troponin level and an ECG. Which response from the nurse is most appropriate? If you had a heart attack, the ECG will be back to normal now. We just need this as a baseline Both the ECG and troponin levels may be abnormal, even if the heart attack was yesterday The ECG level may show damage to your heart, but the troponin level will no longer be accurate If you had come in when you were having chest pains, we would have more accurate outcomes. These results may be skewed now
Both the ECG and troponin levels may be abnormal, even if the heart attack was yesterday A client may experience a heart attack but may not necessarily know if it was an actual myocardial infarction or simply angina. The outcome may not be obvious right away, but laboratory levels can be drawn that will demonstrate changes in cardiac enzymes showing if the client actually suffered damage to the heart muscle. The troponin levels may remain abnormal for up to ten days after a heart attack. Additionally, an ECG may also demonstrate changes as part of the fully evolved post-myocardial stage, which occurs within hours to days after a heart attack.
The client presents to the emergency department complaining of chest pain for the past 2 hours. The client is breathing, alert, and oriented. What is the firstaction the nurse should take? Get vital signs Start an IV Call the provider Get an EKG
Get an EKG The priority intervention for the nurse is to get an EKG started to verify whether the client is having a myocardial infarction. Vital signs and an IV start will occur immediately after the nurse gets the EKG, or the nurse will delegate to another nurse if one is available. the EKG is a priority because the provider will need to look see the EKG results as soon as they are available.
A nurse assigned to four clients is receiving report. The nurse knows that the client with which of the following is the most at risk for developing coronary artery disease? History of drinking a glass of wine per day and hypotension History of hypertension and hyperlipidemia Smoking cessation 10 years ago and history of gastritis Anemia and multiple blood infusions
History of hypertension and hyperlipidemia This client has a history of hypertension and hyperlipidemia which are both causes of coronary artery disease.
A nurse is caring for a client who underwent open-heart surgery 12 hours ago. While recovering, the client develops chest pain and becomes very restless. After testing, the provider determines that the client has developed cardiac tamponade. Which describes the most likely treatment for this condition? Electrocardiogram Echocardiogram Pericardiocentesis Swan-Ganz insertion
Pericardiocentesis Cardiac tamponade develops when fluid accumulates in the pericardial sac that surrounds the heart. The condition can be life threatening if too much fluid accumulates because the fluid compresses and squeezes the heart, preventing adequate filling of the ventricles which reduces cardiac output. Cardiac tamponade is treated by pericardiocentesis, in which the provider inserts a needle into the pericardial sac and drains the fluid. The provider may use an echocardiogram to guide the needle to ensure that it does not puncture the heart.
Which best describes in-stent restenosis following stent placement? The overgrowth of tissue in a stent that causes a blockage in the artery A loss of blood flow because of failure of the cardiac stent An increase in left atrial pressure due to backup of fluid and blood in the pulmonary system A significant rise in blood pressure as a result of stent blockage to essential organs
The overgrowth of tissue in a stent that causes a blockage in the artery
A client has been prescribed sublingual nitroglycerin to use PRN for chest pain. The nurse is teaching the client how to administer the medication. Which of the following statements by the nurse is correct? "Swallow this medication with a full glass of water" "Place this tablet in your cheek and let it dissolve" "Put the tablet on your tongue for one minute, then chew and swallow" "Place the tablet under your tongue until it has dissolved completely"
"Place the tablet under your tongue until it has dissolved completely" Nitroglycerin is a medication that dilates blood vessels to allow more blood to flow through them, which can effectively treat episodes of chest pain by dilating the coronary arteries. Sublingual medication is administered under the tongue to dissolve completely to get the full effect of the medication. The nurse should teach the client in this situation to place the nitroglycerin tablet under his tongue and let it dissolve, rather than chewing it or swallowing the tablet before it has dissolved.
A client who has just undergone angiography in the cardiac cath lab has returned to the room on the nursing unit. Which actions of the nurse would be appropriate in caring for this client to prevent complications after the procedure? Select all that apply. A. Provide pain medication as needed B. Check circulation of peripheral extremities frequently C. Keep the client on bed rest for 30 minutes after the procedure D. Position the client on the side opposite the insertion site E. Assess for heat, pain, and redness at the insertion site
A, B, & E Angiography involves insertion of a catheter into the femoral artery for coronary intervention. The client is at risk of bleeding from the catheter insertion site and should be monitored carefully. The nurse should have the client stay on bed rest after the procedure as ordered for up to 12 hours, monitor the insertion site for signs of bleeding or hematoma, and provide pain medication as needed. The client should be positioned as ordered, usually supine with the bed flat.
A nurse is preparing a client for coronary artery bypass graft surgery. Which preop interventions would the nurse use that would help with prevention of bleeding after the surgery? Select all that apply. A. Determining whether the patient has a clotting factor deficiency B. Checking if the patient has had bleeding with prior surgeries C. Administering clopidogrel prior to surgery D. Performing a P2Y12 assay E. Stopping warfarin administration 12 hours before surgery
A, B, & D Part of assessment and preparation for the surgical client is to determine bleeding risk. A P2Y12 assay is a test to determine the level of antiplatelet mechanisms in the client, and is specifically useful for coronary artery bypass graft surgery If a client has a clotting factor deficiency such as Von Willebrand disease, the provider must be aware of this prior to surgery. Additionally, it is helpful to know if the client has had problems with bleeding in the past.
The nurse is discharging a client being treated for hyperlipidemia and hypertension. The client smokes occasionally to decrease stress from work and has just been diagnosed with coronary artery disease. Which of the following client education topics should the nurse include? Select all that apply. A. Quit smoking B. Continue taking statins C. Stop taking blood pressure medications D. Manage stress in life E. Decrease physical activity
A, B, & D. The client should quit smoking because it causes damage to the vessel walls, allowing plaque to stick which will worsen coronary artery disease The client should manage stress because it can cause and worsen coronary artery disease. The client should continue taking statins to help with their cholesterol, which will worsen coronary artery disease
A client who has recovered from a heart attack has been moved to a different unit in the hospital and placed on telemetry. As the nurse is connecting the electrodes to the client, he asks, "Why do I have to wear this?" What information should the nurse give this client about telemetry? Select all that apply. A. The telemetry will monitor the client's heart rhythm during his hospital stay B. The electrodes on the chest are leads connected to wires that transmit signals to the monitor C. The client will not be able to ambulate while being monitored by telemetry D. The telemetry is always monitored by a provider E. The telemetry allows the client's heart rate to be monitored from a desk outside of the room
A, B, & E The telemetry will monitor the client's heart rhythm during his hospital stay This is the correct purpose of telemetry monitoring. The telemetry allows the client's heart rate to be monitored from a desk outside of the room Telemetry is a system of cardiac rhythm monitoring that can be done from a remote area of the building. The client is connected to a telemetry box that sends signals to a central location, which is constantly monitored by a telemetry technician. The electrodes on the chest are leads connected to wires that transmit signals to the monitor This is the correct set-up for telemetry monitoring.
A nurse assigned to a client diagnosed with coronary artery disease knows to implement which of the following orders that will help treat the disease? Select all that apply. A. Angioplasty and stent placement B. Electrocardiogram (EKG) C. Calcium channel blockers D. Statins E. Echocardiogram
A, C, & D Angioplasty and stent placement may be done to open clogged vessels to allow for blood flow to the heart and treat the disease. Calcium channel blockers may be prescribed to relax or dilate the vessels, allowing for blood flow through them to the heart, which will help treat the disease. Statins may be prescribed to decrease the cholesterol, and therefore lowering the plaque in the blood that may stick to the walls, which will help treat the disease and prevent it from worsening.
What are the names of the (5) locations for auscultating Heart Sounds? Describe where each location can be found.
APE To Man A-Aortic P-Pulmonic E-Erbs points T-Tricuspid M-Mitral Aortic and Pulmonic (A&P): 2 words, 2 spaces; these coincide in that they are both in the 2nd intercostal space. A is immediately to the right of the sternum, P is immediately to the left of the sternum. Erb's point: Erb has 3 letters; you can find this point in the 3rd intercostal space (just to the left of the sternum), also the 3rd space to auscultate Tricuspid: 5th intercostal, just to the left of the sternum. Tri = 3, this is the fourth place to auscultate in the 5th intercostal space! Mitral: Mit sounds similar to mid.. Midclavicular area and straight down just below nipple line.
A nurse is caring for a client who is undergoing angiography to assess the coronary vessels. The nurse has ensured that the client signed the consent and has been NPO for the past 8 hours. Which of the following actions should the nurse do nextbefore the start of the procedure? Administer methylprednisolone as ordered Administer an infusion of albumin Ask the client if he or she is having chest pain Assess the groin site
Administer methylprednisolone as ordered Prior to starting angiography, the nurse may administer a corticosteroid to the client to prevent a reaction from the procedure. Since dye is administered into circulation to view the blood vessels, there is a chance that the client would have a reaction to the dye. Corticosteroids reduce inflammation that can also occur during the procedure as a reaction to the process.
A patient who has been experiencing chest pain takes aspirin when he has an attack of angina. Which of the following are contraindications to aspirin use? Select all that apply. A patient who has mitral valve prolapse The presence of inflammation An allergy to NSAIDs Thrombocytopenic purpura A child with chicken pox
An allergy to NSAIDs Thrombocytopenic purpura A child with chicken pox Aspirin is an NSAID. Aspirin affects coagulation and should not be taken by patients with a bleeding disorder. Aspirin causes Reye's syndrome, which is a serious and sometimes fatal condition in children is caused by aspirin. The risk for Reye's syndrome is higher when the child has a fever, flu symptoms and chickenpox.
A nurse is working on the rapid response team (RRT) of the hospital and is called for a situation in which a patient with acute coronary syndrome is experiencing chest pain and shortness of breath. The nurse has standing orders for administration of drugs in this situation. Which of the following medications would most likely be administered firstafter the nurse arrives? Acetaminophen Aspirin Sodium bicarbonate Atenolol
Aspirin When a patient is experiencing chest pain but has not collapsed, the nurse should administer a dose of aspirin as an initial drug. Aspirin is an anti-platelet medication, which slows platelet aggregation and improves blood flow. The recommended dose for a patient with acute coronary syndrome is 160 to 325 mg of baby aspirin.
The nurse is caring for a client who suffered a myocardial infarction. Which of the following is NOT a complication due to an MI? Postinfarction angina Bowel stricture Heart failure Thrombophlebitis
Bowel stricture A bowel stricture, or narrowing of the bowel, is not a complication related to myocardial infarction. A bowel stricture is commonly caused by Crohn's disease, due to inflammation and scarring of the bowel. This can lead to a bowel obstruction.
A 77-year-old client is seen in the ED for chest pain. The provider orders lab work to determine if damage has been done to the heart muscle. Which lab test is a cardiac enzyme that would be ordered to check for heart damage? Bromelain CK-MB Phytase Diastase
CK-MB When a myocardial infarction occurs, the damaged myocardium releases certain enzymes into the bloodstream. By checking for an elevation in the enzymes, the provider can determine if damage has been done to the heart muscle. The types of cardiac enzymes checked include troponins and creatine-kinase myocardial bands (CK-MB).
Which of the following medications lower blood pressure by reducing cardiac cell excitability? Beta-adrenoceptors Calcium channel blockers Diuretics ACE inhibitors
Calcium channel blockers When calcium enters the cell, it causes the cell to contract. Therefore, calcium channel blockers reduce cardiac cell excitability.
The nurse is caring for a client with a chief complaint of angina. Which lab panel does the nurse anticipate being ordered? Cardiac panel Renal panel Thyroid panel Liver panel
Cardiac panel Angina is a condition of the heart involving chest pain due to inadequate blood flow to the heart. The nurse would anticipate a cardiac panel to rule out a myocardial infarction.
A 44-year-old client is recovering in the hospital following a myocardial infarction. The client asks the nurse about participation in cardiac rehabilitation. Which of the following is an accurate explanation of cardiac rehabilitation? Cardiac rehabilitation is designed only for people who were born with congenital heart disease and have experienced a heart attack Cardiac rehabilitation is designed for people over the age of 60 for additional physical therapy after a heart attack Cardiac rehabilitation can help you to improve activity levels and exercise tolerance after a heart attack Cardiac rehabilitation is designed to teach a person what to do if they have a heart attack again
Cardiac rehabilitation can help you to improve activity levels and exercise tolerance after a heart attack Cardiac rehabilitation is available for clients with many different types of cardiac conditions, including following treatment of an MI. Cardiac rehabilitation helps to strengthen the client's heart by increasing exercise tolerance. The program also helps the client regarding other issues that may occur following treatment of heart disease, such as counseling for dietary problems, help with stress levels, and care of psychosocial issues.
Four clients in the emergency room have complaints of chest pain. The nurse should see the client with which of the following first? Chest discomfort with history of COPD Chest pain after a motor vehicle accident Chest pain and is diaphoretic Chest pain with anxiety
Chest pain and is diaphoretic Crushing chest pain and diaphoresis would be prioritized over any other chest pain and the COPD. While each client's need is somewhat urgent, the chest pain with diaphoresis is indicative of an acute myocardial infarction and therefore requires immediate attention.
A client who has suffered a myocardial infarction requires percutaneous transluminal coronary angioplasty. The nurse is preparing the client for the procedure. Which information should be given as part of pre-operative teaching for the client? Explain that the client will have a sand bag or closure device placed on the site to provide pressure after the procedure Discuss that the client will have some body hair shaved and he will feel a cold, tingling sensation during the procedure Tell the client that he will not be awake during the procedure and he won't feel a thing Describe the procedure, its risks and benefits, and potential alternative treatments
Explain that the client will have a sand bag or closure device placed on the site to provide pressure after the procedure
A 74-year-old client has suffered a myocardial infarction; the critical care team places the client into a state of hypothermia as part of treatment. Which bestdescribes why hypothermia is used after cardiac arrest? Hypothermia prevents the body from secreting hormones that could further damage ischemic tissue Hypothermia prevents other complications from developing, such as hypoglycemia and seizures Hypothermia stops blood flow that would otherwise cause an immune response and inflammation Hypothermia protects the brain from damage caused by ischemia by slowing the brain's metabolism
Hypothermia protects the brain from damage caused by ischemia by slowing the brain's metabolism Therapeutic hypothermia, also known as targeted temperature management (TTM) is a form of treatment that may be used among some clients who have suffered a cardiac arrest. A client may be placed in a state of hypothermia after a myocardial infarction when his heart and brain have suffered damage from lack of oxygen. Research has shown that therapeutic hypothermia protects the brain from ischemic damage by slowing the brain's metabolism, resulting in improved neurological outcomes.
A nurse in the emergency room has clients that are all complaining of pain. The nurse knows that the client having pain in which of the following areas is the priority? Bilateral flank Lower abdomen Lower back Jaw and neck
Jaw and neck These symptoms can occur in a client having a myocardial infarction, especially in a female client. This client should be seen first to rule out an MI.
Angina treatment Acronym
MONA M-Morphine O-Oxygen N-Nitrates A-Aspirin (ASA) The treatment protocol for angina is morphine, oxygen, nitroglycerin, and aspirin. Morphine works to decrease pain and difficulty breathing, oxygen ensures that poorly oxygenated tissues receive the required oxygen, nitroglycerin is a potent vasodilator and aids in restoring oxygenation to tissues, aspirin helps to thin the blood and increase tissue perfusion.
A client has undergone percutaneous coronary intervention (PCI) for the management of acute coronary syndrome. Following the procedure, the client develops a retroperitoneal hemorrhage. Which of the following nursing interventions is necessary if this occurs? Apply pressure to the lower back Assist the client to get out of bed to ambulate Prepare for intubation and mechanical ventilation Notify provider and prepare for CT scan or blood administration
Notify provider and prepare for CT scan or blood administration Retroperitoneal hemorrhage is a complication of PCI when there is bleeding into the retroperitoneal cavity. The client may have a drop in blood pressure and the situation could become severe if bleeding is not controlled. The nurse should have the patient rest and increase fluid administration. If the client is not stable, the provider must be notified, and a CT scan will likely be o
The nurse is assessing a client who is coughing so hard that his chest hurts. The client is holding his chest and asking for pain medications. What is the priority for this client? Give the client water Give the client pain medications Obtain orders for an EKG (ECG) Get the client cough syrup
Obtain orders for an EKG (ECG) Because the client is clutching his chest and asking for pain medications, the nurse should talk to the provider about an order for an EKG. The pain may be from coughing, but the nurse should not assume that the heart is fine if the client is demonstrating these symptoms.
A client with a history of coronary artery disease and diabetes has complaints of chest pain that does not go away when resting. The organization has a chest pain protocol for nurses that starts with obtaining an EKG. Which of the following actions should the nurse take? Call the healthcare provider Administer metoprolol 25 mg PO Order STAT EKG per protocol Prepare the client for stent placement
Order STAT EKG per protocol The nurse should order a STAT EKG per the protocol and then may call the doctor with the results if they aren't on the unit.
A client is preparing to undergo a procedure in which a balloon-tipped catheter is inserted into a coronary artery blocked by atherosclerosis to dilate the size of the vessel and improve blood flow. This procedure is best known as: Transmyocardial revascularization Percutaneous transluminal coronary angioplasty Directional coronary atherectomy Cardiomyoplasty
Percutaneous transluminal coronary angioplasty Percutaneous transluminal coronary angioplasty (PTCA) is a procedure that is used to restore blood flow in an artery blocked by atherosclerosis. PTCA involves inserting a balloon-tipped catheter into the blocked vessel and advancing it through an atherosclerotic lesion where it is then inflated. This process dilates the size of the vessel, making room for blood to flow through.
A client on the cardiac unit complains of chest pain to the nurse. The nurse calls a rapid response and the healthcare provider arrives in the room. Vital signs are as follows: Blood pressure 182/98 HR 98 Respirations 23 Temperature 98.9 The nurse orders a STAT EKG per protocol, which shows a widened ST segment. Which of the following interventions should the nurse implement first? Client teaching on the importance of smoking cessation Prepare the client for angioplasty Administer simvastatin 50 mg PO OT Check vital signs
Prepare the client for angioplasty A widened ST-segment shows STEMI and is a serious condition requiring immediate intervention. The nurse should prepare the client for an angioplasty where the vessels will be opened removing the blockage.
The nurse is caring for a client who was just administered an antianginal agent in the form of a nitrate. The nurse knows that this helps angina by which of the following mechanisms? Dilates capillaries in the messentary Reducing venous tone, decreasing cardiac workload Decreasing heart rate Increase arterial pressure
Reducing venous tone, decreasing cardiac workload Nitrates reduce venous tone, decreasing cardiac workload and reducing myocardial oxygen consumption.
A nurse is caring for a client with stable angina. The nurse understands that stable angina is which of the following? Stable angina is also called preinfarction angina Stable angina is constantly present Stable angina steadily increases in severity over time Stable angina can occur when the client exercises or is under emotional stress
Stable angina can occur when the client exercises or is under emotional stress
A nurse is conducting a pre-op screening on a client preparing for a coronary artery bypass graft procedure. Which substance used by the client can indicate that the client is at higher risk of post-op bleeding? Loperamide Omeprazole Bisacodyl Vitamin E supplements
Vitamin E supplements When performing a pre-op assessment, the nurse must check whether the client takes medications that could increase the risk of bleeding. With certain procedures, such as a CABG, the risk of bleeding is even greater because of the surgery's complexity. Over-the-counter medications that can increase the risk of bleeding include supplements such as vitamin E, cayenne, turmeric, gingko, garlic, or ginseng, as well as some analgesics, such as ibuprofen.
