Ch. 56 ST-Elevation MI Management
The nurse in the emergency department is receiving a report on a patient diagnosed with ST-elevation myocardial infarction (STEMI). What are the common biochemical markers and symptoms for an STEMI? (Select all that apply.) Chest pain and electrocardiographic (ECG) changes Decreased troponin I level Elevated troponin T level Elevated creatinine kinase level Weakness and diaphoresis
A, C, D, & E; Patients experiencing STEMI typically present with chest pain, an elevated ST segment on the ECG, elevated levels of cardiac cell components (e.g., troponin and creatinine kinase), sweating, weakness, and a sense of impending doom.
The nurse is teaching a patient who has had an ST-segment elevation myocardial infarction (STEMI) about home medications. Which agent represents a drug category that should be taken by all post-MI patients? Metoprolol [Lopressor] Hydrochlorothiazide (HCTZ) Diltiazem [Cardizem] Lovastatin [Mevacor]
A; All post-MI patients should take a beta blocker (metoprolol), an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), and an antiplatelet or anticoagulant agent. Although the other agents may be warranted, these three categories are universally indicated after an MI.
patient is admitted to the emergency department with a diagnosis of ST-segment elevation myocardial infarction (STEMI). Which is the priority nursing action? Having the patient chew a 325-mg aspirin Administering meperidine [Demerol] for pain relief Giving verapamil [Calan] to lower blood pressure Preparing an insulin drip to manage complications
A; In this situation, the nurse's top priority is to have the patient chew a 325-mg aspirin. Several other nursing actions also are important in patients with STEMI, including oxygen administration, morphine for pain relief and venodilation, beta blockers and nitroglycerin to improve hemodynamics, and reperfusion therapy by means of percutaneous intervention or fibrinolytics. Meperidine would not be an analgesic of choice. Verapamil is a calcium channel blocker, and these drugs are no longer considered beneficial in patients with STEMI. Most agents used for STEMI do not cause hyperglycemia; therefore, an insulin drip is not indicated.
A patient is admitted to the emergency department complaining of chest pain, and the electrocardiogram (ECG) shows an evolving ST-segment elevation myocardial infarction (STEMI). What intervention should the nurse anticipate? Administer 400 mg of ibuprofen. Have the patient chew a 325-mg aspirin. Administer an ACE inhibitor within 1 week of the onset of chest pain. Provide oxygen by nasal cannula to achieve an arterial oxygen saturation of 94%.
B; The first dose of aspirin (162 to 325 mg) should be given immediately after the onset of symptoms or as soon as possible. Each baby aspirin (81 mg) should be chewed to allow rapid absorption across the buccal mucosa. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are avoided, because they increase the risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture. Current guidelines recommend administration of oxygen by nasal cannula only if the arterial oxygen saturation is below 90%. Treatment with ACE inhibitors should begin within 24 hours of symptom onset.
Which adverse effect is the greatest concern with thrombolytic therapy? Anaphylaxis Intracranial hemorrhage Cerebral edema Hemophilia
B; The major complication of thrombolytic therapy is bleeding. Intracranial hemorrhage (ICH) is the greatest concern.
Which drug would not be included in the treatment plan for a patient who will undergo a primary percutaneous coronary intervention (PCI)? Aspirin Heparin Diltiazem [Cardizem] Clopidogrel [Plavix]
C; Diltiazem is not indicated for a patient undergoing primary PCI. All patients undergoing PCI should receive an anticoagulant (IV heparin, bivalirudin) combined with antiplatelet drugs: aspirin plus either clopidogrel, ticagrelor, or prasugrel.
ch medication is the treatment of choice for ST-segment elevation myocardial infarction (STEMI)-associated pain? Aspirin Lorazepam [Ativan] Morphine Hydromorphone hydrochloride [Dilaudid]
C; Morphine improves hemodynamics. By promoting venodilation, the drug reduces cardiac preload. By promoting modest arterial dilation, it may cause some reduction in afterload. The combined reductions in preload and afterload lower the cardiac oxygen demand, thereby helping to preserve the ischemic myocardium and relieving the patient's pain.
The nurse is preparing to administer an intravenous (IV) nitroglycerin infusion. For which patient should the nurse question the healthcare provider's prescription to administer IV nitroglycerin infusion? A patient with an inferior wall myocardial infarction (MI); blood pressure of 170/60 mm Hg A patient with an anterior wall MI who has pulmonary congestion; heart rate of 92 beats/min A patient with a right ventricular infarction, confirmed by right-sided ECG changes A patient with chest pain unrelieved to 3 sublingual nitroglycerin tablets; took tadalafil 4 days ago
C; Nitroglycerin should be avoided in patients with hypotension (systolic BP below 90 mm Hg), severe bradycardia (heart rate below 50 beats/min), marked tachycardia (heart rate above 100 beats/min), or suspected right ventricular infarction. If the patient has taken sildenafil, avanafil, or vardenafil in the past 24 hours or tadalafil in the past 48 hours, nitroglycerin should not be given. According to current guidelines, the patient should receive 3 doses of sublingual nitroglycerin before a continuous infusion is considered. Signs of pulmonary congestion also warrant use of IV nitroglycerin.
Which is the most beneficial treatment for patients experiencing an ST-segment elevation myocardial infarction (STEMI)? Oxygen administration Metoprolol [Lopressor] Reperfusion therapy Lidocaine [Xylocaine]
C; Reperfusion therapy restores blood flow through the blocked coronary arteries responsible for the MI. Reperfusion therapy can be accomplished through percutaneous coronary intervention or fibrinolytic therapy.
For all patients undergoing percutaneous coronary intervention (PCI), which drug is recommended to be combined with clopidogrel [Plavix]? Heparin ACE inhibitor Alteplase [Activase] Aspirin
D; In patients undergoing PCI, clopidogrel is used in combination with aspirin. Aspirin suppresses platelet aggregation, thereby reducing mortality by reducing the likelihood of reinfarction or stroke.
The nurse understands that ventricular fibrillation is a common cause of death after myocardial infarction (MI). Which drug should be readily available to treat ventricular fibrillation? Propranolol [Inderal] Dobutamine Valsartan [Diovan] Amiodarone [Cordarone]
D; The priority treatment of ventricular fibrillation involves defibrillation, followed by intravenous (IV) amiodarone infusion for 24 to 48 hours. The other agents may be used in the treatment of a patient with MI, but amiodarone is the specific agent used to treat ventricular fibrillation.