Chapter 13 - Cardiovascular Alterations
The nurse explains to the new RN that angiotensin-converting enzyme inhibitors (ACE inhibitors) should be started within 24 hours of acute myocardial infarction (AMI). Which statement by the new RN indicates that teaching has been effective? A. "ACE inhibitors are started within 24 hours to prevent tachycardia." B. "ACE inhibitors are started within 24 hours to prevent myocardial stunning." C. "ACE inhibitors are started within 24 hours to prevent myocardial remodeling." D. "ACE inhibitors are started within 24 hours to prevent hibernating myocardium."
"ACE inhibitors are started within 24 hours to prevent myocardial remodeling." Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines; it causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors should be ordered.
Which statements related to the management of unstable angina are true? (Select all that apply.) A. Early revascularization (e.g., angioplasty) may be helpful. B. Calcium channel blockers help to reduce symptoms. C. Aspirin is given at the onset of each chest pain episode. D. It is best treated with rest and nitroglycerin.
A. Early revascularization (e.g., angioplasty) may be helpful. B. Calcium channel blockers help to reduce symptoms. C. Aspirin is given at the onset of each chest pain episode. Unstable angina can be treated by conservative management or early intervention with percutaneous intervention or surgical revascularization. Conservative intervention for the patient experiencing angina includes the administration of nitrates, beta-adrenergic blocking agents, and/or calcium channel blocking agents. Angioplasty, stenting, and bypass surgery are approaches to revascularization. Rest and nitroglycerin are treatments for stable angina. Aspirin is not a typical treatment for unstable angina.
The patient presents to the emergency department after having crushing chest pain for the past 5 hours. The ECG and laboratory work confirm suspicions of an acute myocardial infarction (AMI). Which findings would be the most conclusive that the patient is having an AMI? (Select all that apply.) A. Elevated CK-MB isoenzymes B. ECG changes with ST-elevation C. Elevated serum troponin levels D. Elevated urinary myoglobin level
A. Elevated urinary myoglobin level B. ECG changes with ST-elevation ST-segment elevation and elevated cardiac enzymes are seen in Q-wave MI. Serum Troponin may assist in diagnosis of AMI.
The nurse is caring for a patient with a diagnosis of acute myocardial infarction (AMI). Which medication should the nurse anticipate administering to the patient to reduce platelet aggregation? A. Nitroglycerin B. Lidocaine C. Oxygen D. Aspirin
Aspirin Aspirin blocks synthesis of thromboxane A2, thus inhibiting aggregation of platelets.
A patient is complaining of midsternal chest discomfort radiating down the right arm. The discomfort has been present for about 5 minutes. The patient is also asthmatic and allergic to calcium channel blockers. The nurse anticipates an order from the health care provider for which medication? A. Isoptin B. Nifedipine C. Metoprolol D. Nitroglycerin sublingual
Nitroglycerin sublingual These are symptoms of angina. Administration of nitrates is indicated as a first-line treatment.
The nurse is caring for a patient who has symptoms of an acute myocardial infarction (AMI). Which lab should the nurse prepare to draw in order to detect myocardial necrosis? A. Troponin I B. CK C. Potassium D. CK-MB
Troponin I Troponin I has a greater specificity than other tests in the diagnosis of acute myocardial infarction (AMI) at 7 to 14 hours after the onset of chest pain.
An adult patient suffered an anterior wall myocardial infarction (MI) 4 days ago. Today the patient is experiencing dyspnea and sitting straight up in bed. The nurse's assessment includes bibasilar crackles, an S3 heart sound with a heart rate of 125 beats/min. The nurse anticipates a diagnosis of A. Heart Attack B. Pulmonary Embolism C. papillary muscle rupture. D. pericarditis.
heart failure. These are classic signs of fluid overload and heart failure. Presence of a heart murmur, not the S3, might alert the nurse to a papillary muscle rupture. The patient with pericarditis may have chest pain and a pericardial friction rub. The patient with a pulmonary embolism has symptoms including difficulty in breathing, cyanosis, chest pain and possibly death.
A 67-year-old female is admitted to the emergency department complaining of midback pain and shortness of breath for the preceding 2 hours. She also complains of nausea and states that she vomited twice before coming to the hospital. She denies any chest discomfort or arm pain. The nurse prepares to the treat the patient for a diagnosis of A. anxiety attack. B. osteoporosis. C. flu symptoms. D. myocardial infarction (MI).
myocardial infarction (MI). Women are more likely to have atypical signs and symptoms of acute myocardial infarction (AMI), such as shortness of breath, nausea and vomiting, and back or jaw pain.
The patient, who is being treated for hypercholesterolemia, complains of hot flashes and a metallic taste in the mouth. The nurse educates the patient that this is a side effect of A. bile acid resins. B. statins C. nicotinic acid. D. clopidogrel.
nicotinic acid. Common side effects of nicotinic acid include metallic taste in mouth, flushing, and increased feelings of warmth.
The patient presents to the emergency department with severe substernal chest discomfort. Cardiac enzymes are elevated, and his ECG shows ST-segment depression in V2 and V3. The nurse anticipates a diagnosis of A. non-Q-wave myocardial infarction (MI). B. pulmonary embolism. C. right ventricular infarction D. Q-wave myocardial infarction (MI).
non-Q-wave myocardial infarction (MI). The non-Q-wave MI usually results from a partially occluded coronary vessel, and it is associated with ST-segment depression in two or more leads, along with elevated cardiac enzymes.
