Angina, MI, Aneurysms Questions (NCLEX)

A client admitted with angina compains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? A) Activate the resuscitation team B) Open the client's airway C) Check for breathing D) Check for signs of circulation

A) Activate the resuscitation team Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and feeling for no more than 10-seconds). If the client isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse.

Which of the following terms describes the force against which the ventricle must expel blood? A) Afterload B) Cardiac output C) Overload D) Preload

A) Afterload Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

The nurse teaches the client that the major difference between angina and pain associated with myocardial infarction (MI) is that: A) Angina is relieved with nitroglycerin and rest. B) Angina can be fatal. C) MI pain always radiates to the left arm or jaw. D) MI pain cannot be treated.

A) Angina is relieved with nitroglycerin and rest.

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A) Beta-adrenergic blockers B) Calcium channel blockers C) Narcotics D) Nitrates

A) Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

Which of the following is the most common symptom of myocardial infarction (MI)? A) Chest pain B) Dyspnea C) Edema D) Palpitations

A) Chest pain The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights? A) Digoxin B) Furosemide (Lasix) C) Metoprolol (Lopressor) D) Enalapril (Vasotec)

A) Digoxin One of the most common signs of digoxin toxicity is the visual disturbance known as the "green-yellow halo sign." The other medications aren't associated with such an effect.

A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is: A) Normal sinus rhythm B) Sinus bradycardia C) Sinus tachycardia D) Sinus dysrhythmia

A) Normal sinus rhythm

The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following? A) Obtaining an infusion pump for the medication B) Monitoring BP q4h C) Monitoring urine output hourly D) Obtaining serum potassium levels daily

A) Obtaining an infusion pump for the medication IV nitro infusion requires an infusion pump for precise control of the medication. BP monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.

Which of the following results is the primary treatment goal for angina? A) Reversal of ischemia B) Reversal of infarction C) Reduction of stress and anxiety D) Reduction of associated risk factors

A) Reversal of ischemia Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed.

Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking? A) Sit the client down B) Get the client back to bed C) Obtain an ECG D) Administer sublingual nitroglycerin

A) Sit the client down The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is sitting down. After the ECGm sublingual nitro would be administered. When the client's condition is stabilized, he can be returned to bed.

Which of the following complications is indicated by a third heart sound (S3)? A) Ventricular dilation B) Systemic hypertension C) Aortic valve malfunction D) Increased atrial contractions

A) Ventricular dilation Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as a murmur

What is the first intervention for a client experiencing MI? A) Administer morphine B) Administer oxygen C) Administer sublingual nitroglycerin D) Obtain an ECG

B) Administer oxygen Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI

Aspirin is administered to the client experiencing an MI because of its: A) Antipyrectic action B) Antithrombotic action C) Antiplatelet action D) Analgesic action

B) Antithrombotic action Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.

The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information must the nurse include? A) Limit exercise to 30 minutes twice per week. B) Avoid alcohol consumption. C) Monitor intake and output. D) Report skin flushing to the physician.

B) Avoid alcohol consumption.

Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? A) Antihypertensives B) Beta-adrenergic blockers C) Calcium channel blockers D) Nitrates

B) Beta-adrenergic blockers By decreasing the heart rate and contractility, beta-blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated because they would decrease cardiac output in clients who are already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as effective as beta-blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium.

The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by: A) Increasing preload. B) Decreasing afterload. C) Positive chronotropic effect. D) Positive inotropic effect.

B) Decreasing afterload. Rationale: Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload). This decreases myocardial oxygen demand, and reduces frequency of anginal pain.

What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina? A) Discontinue drug if heart rate <60. B) Do not discontinue drug abruptly. C) Exercise heart rate should be 110-120. D) Monitor for hyperglycemia.

B) Do not discontinue drug abruptly. Rationale: Beta blocker treatment should never be abruptly discontinued. With abrupt cessation, a rebound excitation occurs, and adrenergic receptors are stimulated. This can exacerbate angina, increase heart rate, and cause myocardial infarction. Clients often tolerate heart rates as low as 50. The beta blocker might blunt the compensatory increase in heart rate with exercise. Hypoglycemia can occur.

Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease? A) Decrease anxiety B) Enhance myocardial oxygenation C) Administer sublingual nitroglycerin D) Educate the client about his symptoms

B) Enhance myocardial oxygenation Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.

A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client? A) Anxiety B) Ineffective tissue perfusion; cardiopulmonary C) Acute pain D) Ineffective therapeutic regimen management

B) Ineffective tissue perfusion; cardiopulmonary MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion (cardiopulmonary). Anxiety, acute pain, and ineffective therapeutic regimen management are appropriate but don't take priority

The nurse recognizes that the mechanism for action of beta-adrenergic blockers in the treatment of angina is: A) Positive chronotropic effect. B) Negative inotropic effect. C) Positive inotropic effect. D) Antidysrhythmia.

B) Negative inotropic effect. Rationale: Beta blockers decrease the workload of the heart by slowing heart rate (negative chronotropic effect) and reducing contractility (negative inotropic effect).

Which of the following reflects the principle on which a client's diet will most likely be based during the acute phase of MI? A) Liquids as ordered B) Small, easily digested meals C) Three regular meals per day D) NPO

B) Small, easily digested meals Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are better tolerated. Fluids are given according to the client's needs, and sodium restrictions may be prescribed, especially for clients with manifestations of heart failure. Cholesterol restrictions may be ordered as well. Clients are not prescribed a diet of liquids only or NPO unless their condition is very unstable.

Which of the following conditions is most commonly responsible for myocardial infarction? A) Aneurysm B) Heart failure C) Coronary artery thrombosis D) Renal failure

C) Coronary artery thrombosis Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Renal failure can be associated with MI but isn't a direct cause. Heart failure is usually a result from an MI.

The nurse determines that treatment of a client with a beta-adrenergic blocker for myocardial infarction has been effective when: A) Tachycardia occurs. B) Blood pressure is 90/50. C) Decreased dysrhythmias occur. D) Decreased urinary output occurs.

C) Decreased dysrhythmias occur. Rationale: Beta blockers have the ability to decrease heart rate, decrease contractility, and decrease blood pressure, leading to decreased oxygen demand. They also slow conduction, which suppresses dysrhythmias. Tachycardia would not be desired with an MI. A low BP alone would not indicate effective treatment of the MI.

If medical treatments fail, which of the following invasive procedures is necessary for treating cariomyopathy? A) Cardiac catherization B) Coronary artery bypass graft (CABG) C) Heart transplantation D) Intra-aortic balloon pump (IABP)

C) Heart transplantation The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible.

A client with a myocardial infarction is admitted to the cardiac unit. The nurse can best determine the effectiveness of the client's ventricular contractions by: A) OBSERVING ANXIETY LEVELS B) EVALUATING ENZYME RESULTS C) MONITORING URINARY OUTPUT HOURLY D) ASSESSING BREATH SOUNDS FREQUENTLY

C) MONITORING URINARY OUTPUT HOURLY

Medical treatment of coronary artery disease includes which of the following procedures? A) Cardiac catherization B) Coronary artery bypass surgery C) Oral medication therapy D) Percutaneous transluminal coronary angioplasty

C) Oral medication therapy Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised. 3. Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.

Which of the following blood tests is most indicative of cardiac damage? A) Lactate dehydrogenase B) Complete blood count (CBC) C) Troponin I D) Creatine kinase (CK)

C) Troponin I Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

What is the most common complication of an MI? A) Cardiogenic shock B) Heart failure C) arrhythmias D) Pericarditis

C) arrhythmias Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.

Which of the following tests is used most often to diagnose angina? A) Chest x-ray B) Echocardiogram C) Cardiac catherization D) 12-lead electrocardiogram (ECG)

D) 12-lead electrocardiogram (ECG) The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina, the ECG shows ST-segment elevation. A chest x-ray will show heart enlargement or signs of heart failure, but isn't used to diagnose angina.

The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? A) Dilating just the coronary arteries B) Decreasing the blood pressure C) Increasing contractility of the heart D) Dilating arteries and veins

D) Dilating arteries and veins

Which diagnostic tool is used to determine the location of myocardial damage for a patient with a myocardial infarction (MI) ? A) CARDIAC CATHETERIZATION B) CARDIAC ENZYMES C) ECHOCARDIAGRAM D) ELECTROCARDIOGRAM (ECG)

D) ELECTROCARDIOGRAM (ECG) ELECTROCARDIOGRAM (ECG) IS THE QUICKEST, MOST ACCURATE AND MOST WIDELY USED TOOL TO DETERMINE THE LOCATION OF A MYOCARDIAL INFARCTION (MI)

Which of the following conditions is the predominant cause of angina? A) Increased preload B) Decreased afterload C) Coronary artery spasm D) Inadequate oxygen supply to the myocardium

D) Inadequate oxygen supply to the myocardium Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes increased cardiac output. Coronary artery spasm is responsible for variant angina.

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: A) It is uncomfortable for the client, giving a sense of impending doom. B) It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. C) It is almost impossible to convert to a normal sinus rhythm. D) It can develop into ventricular fibrillation at any time.

D) It can develop into ventricular fibrillation at any time. Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.

Which of the following symptoms is the most likely origin of pain the client described as knifelike chest pain that increases in intensity with inspiration? A) Cardiac B) Gastrointestinal C) Musculoskeletal D) Pulmonary

D) Pulmonary Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases with movement. Cardiac and GI pains don't change with respiration.

What is the primary reason for administering morphine to a client with an MI? A) To sedate the client B) To decrease the client's pain C) To decrease the client's anxiety D) To decrease oxygen demand on the client's heart

D) To decrease oxygen demand on the client's heart Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons

Which of the following types of angina is most closely related with an impending MI? A) Angina decubitus B) Chronic stable angina C) Noctural angina D) Unstable angina

D) Unstable angina Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.

The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that long-term use can lead to the development of: A) Tolerance. B) Tachycardia. C) Hypotension. D) Urinary retention.

A) Tolerance.

What is the first intervention for a client experiencing myocardial infarction (MI) ? A) ADMINISTER MORPHINE B) ADMINISTER OXYGEN C) ADMINISTER SUBLINGUAL NITROGLYCERIN D) OBTAIN AN ELECTROCARDIOGRAM (ECG

B) ADMINISTER OXYGEN ADMINSTERING SUPPLEMENTAL OXYGEN TO THE CLIENT IS THE NUMBER ONE PRIORITY OF CARE.

Which of the following is an expected outcome for a client on the second day of hospitalization after an MI? A) Has severe chest pain B) Can identify risks factors for MI C) Agrees to participate in a cardiac rehabilitation walking program D) Can perform personal self-care activities without pain

D) Can perform personal self-care activities without pain By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Day 2 hospitalization may be too soon for clients to be able to identify risk factors for MI or begin a walking program; however, the client may be sitting up in a chair as part of the cardiac rehabilitation program. Severe chest pain should not be present.