Critical Care Nursing - Midterm Review - Cardiac Alterations

The nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the critical care nurse? a. "My back is killing me!" b. "There is blood on my toothbrush!" c. "Look at the bruises on my arms!" d. "My arm is bleeding where my IV is!"

a. "My back is killing me!" The nurse must continually monitor for clinical manifestations of bleeding. Mild gingival bleeding and oozing around venipuncture sites are common and not a cause for concern. Severe lower back pain and ecchymoses are suggestive of retroperitoneal bleeding. If serious bleeding occurs, all fibrinolytic heparin therapies must be discontinued, and volume expanders or coagulation factors, or both, are administered.

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. Aspirin b. Lidocaine c. Nitroglycerin d. Oxygen

a. Aspirin Aspirin blocks synthesis of thromboxane A2, thus inhibiting aggregation of platelets.

The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia? a. Second degree heart block b. Atrial fibrillation or flutter c. Ventricular ectopy d. Premature junctional contractions

b. Atrial fibrillation or flutter Atrial fibrillation and flutter are dysrhythmias common after cardiac surgery.

Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink? a. Barium swallow b. Transesophageal echocardiogram c. MUGA scan d. Stress test

b. Transesophageal echocardiogram In transesophageal echocardiogram an ultrasound probe is fitted on the end of a flexible gastroscope, which is inserted into the posterior pharynx and advanced into the esophagus. After the procedure, the patient is unable to eat until the gag reflex returns.

The nurse is assessing a patient diagnosed with L-sided HF. Which symptom would the nurse expect to find? a. Dependent edema b. Distended neck veins c. Dyspnea and crackles d. Nausea and vomiting

c. Dyspnea and crackles In L-sided HF, S/S are related to pulmonary congestion. Dependent edema and distended neck veins are related to R-sided HF.

Acute myocardial infarction (AMI) can be classified as which of the following? (Select all that apply.) a. Angina b. Nonischemic c. Non-Q wave d. Q wave e. Frequent PVCs

c. Non-Q wave d. Q wave AMI can be classified as Q wave or non-Q wave

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 treat the patient for a diagnosis of a. flu symptoms b. anxiety attack c. myocardial infarction (MI) d. osteoporosis

c. myocardial infarction Women are more likely to have atypical signs and symptoms of acute myocardial infarction, such as shortness of breath, nausea and vomiting, and back or jaw pain.

The nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the critical care nurse? a. "I have an incredible headache!" b. "There is blood on my toothbrush!" c. "Look at the bruises on my arms!" d. "My arm is bleeding where my IV is!"

a. "I have an incredible headache!" The nurse must continually monitor for clinical manifestations of bleeding. Mild gingival bleeding and oozing around venipuncture sites are common and not a cause for concern. The worst complication is intracranial bleeding. Any neurological signs and symptoms must be taken seriously, and all fibrinolytic and/or heparin therapies must be discontinued until this is ruled out.

The patient's husband tells the nurse, "We didn't think she was having a heart attack because the pain was in her neck and back." What response should the nurse provide? (Select all that apply.) a. "Pain can occur anywhere in the chest, neck, arms, or back. Don't hesitate to call the emergency medical services if you think it's a heart attack." b. "For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone." c. "The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack." d. "You need to make sure it's a heart attack before you call the emergency response personnel." e. "Often symptoms can be treated with nitroglycerin, so be sure to take several before calling 911."

a. "Pain can occur anywhere in the chest, neck, arms, or back. Don't hesitate to call the emergency medical services if you think it's a heart attack." b. "For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone." c. "The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack." Angina may occur anywhere in the chest, neck, arms, or back, but the most commonly described is pain or pressure behind the sternum. The pain often radiates to the left arm but can also radiate down both arms and to the back, the shoulder the jaw, and/or the neck. In the statement about treating symptoms with nitroglycerin, the word "several" is vague. If a heart attack is suspected, don't hesitate to call 911.

A patient is admitted to the ED with clinical indications of an AMI with symptoms that began 3 hours ago. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient? a. Administer thrombolytic therapy unless contraindicated b. Diurese aggressively and monitor daily weight c. Keep oxygen saturation levels at least 88% d. Maintain heart rate above 100 beats/min

a. Administer thrombolytic therapy unless contraindicated Medical treatment of AMI is aimed at relieving pain, providing adequate oxygenation to the myocardium, preventing platelet aggregation, and restoring blood flow to the myocardium through thrombolytic therapy or acute interventional therapy such as angioplasty. Since intervention cardiology is not available thrombolytic therapy is indicated. Oxygen saturation should be maintained at higher levels to ensure adequate oxygenation to the heart muscle. An elevated heart rate increases oxygen demands and should be avoided. Diuresis is not indicated with this scenario.

*What are the priority interventions for managing symptoms of an acute myocardial infarction in the ED? (Select all that apply.) a. Administration of morphine b. Administration of nitroglycerin c. Dopamine infusion d. Oxygen therapy e. Transfusion of packed red blood cells

a. Administration of morphine b. Administration of nitroglycerin d. Oxygen therapy The intial pain of AMI is treated with morphine sulfate administered intravenously. NTG may be given to reduce the ischemic pain of AMI. NTG increases coronary perfusion because of its vasodilatory effects. Oxygen administration is important for assisting the myocardial tissue to continue its pumping activity and for repairing the damaged tissue around the site of the infarct. Transfusion is not required except in the setting of severe anemia, which may limit oxygen delivery to the heart. Dopamine infusion is usually used to treat hypotension but causes tachycardia which would be deleterious for the patient having an AMI because it increases the heart's workload and demand for oxygen.

A patient is admitted with AMI. The nurse monitors for which potential complications? (Select all that apply.) a. Cardiac dysrhythmias b. Heart failure c. Pericarditis d. Ventricular rupture e. Chest pain

a. Cardiac dysrhythmias b. Heart failure c. Pericarditis d. Ventricular rupture All are potential complications of AMI except chest pain which is a symptom of AMI.

The patient presenting to the ED with severe chest discomfort is taken for cardiac catheterization and angiography that shows 80% occlusion of the left main coronary artery. Which procedure will be most likely followed? a. Coronary artery bypass surgery b. Intracoronary stent placement c. Percutaneous transluminal coronary angioplasty (PTCA) d. Transmyocardial revascularization

a. Coronary artery bypass surgery Coronary artery bypass graft surgery is indicated for significant left main coronary occlusion (> 50%). None of the other options are relevant to this cardiac problem.

The patient diagnosed with chronic heart failure for the past 10 years has been treated with beta-blockers and ACE inhibitors as well as diuretics. The symptoms have recently worsened, and now the patient presents to the ED with severe shortness of breath and crackles throughout lung fields. Respirations are labored and arterial blood gases show that there is at risk for respiratory failure. Which of the following therapies may be used for acute, short-term management of the patient? (Select all that apply.) a. Dobutamine b. Intraaortic balloon pump c. Nesiritide d. Ventricular assist device e. Biventricular pacemaker

a. Dobutamine b. Intraaortic balloon pump c. Nesiritide This patient is showing signs and symptoms of an acute exacerbation of heart failure. Dobutamine and nesiritide are medications administered for acute short-term management; mechanical assist with an intraaortic balloon pump also may be warranted. Mechanical assist with an IABP or insertion of a biventricular pacemaker may also warranted as long-term therapy.

Which statements are true regarding the symptoms of an AMI? (Select all that apply.) a. Dysrhythmias are common occurrences b. Men have more atypical symtpoms than women c. Midsternal chest pain is a common presenting symptom d. Some patients are asymptomatic e. Patients may report jaw or back pain

a. Dysrhythmias are common occurrences c. Midsternal chest pain is a common presenting symptom d. Some patients are asymptomatic e. Patients may report jaw or back pain Chest pain is a common presenting symptom in AMI. Dysrhythmias are commonly seen in AMI. Some individuals may have ischemic episodes without knowing it, thereby having a "silent" infarction. Women are more likely to have atypical signs and symptoms, such as shortness of breath, nausea and vomiting, and back or jaw pain.

*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? a. ECG changes with ST-elevation b. Elevated CK-MB isoenzymes c. Elevated serum troponin levels d. Elevated urinary myoglobin level

a. ECG changes with ST-elevation b. Elevated CK-MB isoenzymes c. Elevated serum troponin levels

A patient has been prescribed nitroglycerin in the ED for chest pain. In taking the health history, the nurse should verify whether the patient has taken medications prior to admission for which condition? a. Erectile dysfunction b. Prostate enlargement c. Asthma d. Peripheral vascular disease

a. Erectile dysfunction A history of the patient's use of sildenafil citrate (Viagra) or similar medications taken for erectile dysfunction is necessary to know when considering NTG administration. These medications potentiate the hypotensive effects of nitrates; thus, concurrent use is contraindicated. It is also important to determine whether the patient has any food or drug allergies.

A patient has been diagnosed with Marfan syndrome. What information does the nurse plan to teach the patient about this condition? a. It is an autosomal dominant inherited disorder of connective tissue b. It is caused by a random genetic mutation and is not familial c. There are no drugs that help control the cardiac symptoms of the disease d. Contact sports are permitted is precautions against concussion are taken

a. It is an autosomal dominant inherited disorder of connective tissue Marfan syndrome is an autosomal dominant inherited disorder of connective tissue with a definite familiar pattern. Beta blockers and ACE inhibitors are commonly used to treat the condition.

Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.) a. Jugular venous distention b. Peripheral edema c. Crackles audible in the lungs d. Weak peripheral pulses

a. Jugular venous distention b. Peripheral edema Jugular venous distention, liver tenderness, hepatomegaly, and peripheral edema are signs of right ventricular failure.

Which symptom would the nurse expect to see in a male patient with ACS? Select all that apply. a. Pain radiation to the arm, neck, and jaw b. Squeezing chest pain c. Nausea and vomiting d. Diaphoresis and pallor

a. Pain radiation to the arm, neck, and jaw b. Squeezing chest pain c. Nausea and vomiting d. Diaphoresis and pallor

The patient is admitted with a suspected AMI. In assessing the 12-lead electrocardiogram changes, which findings would indicate to the nurse that the patient is in the proceses of an evolving Q wave MI? a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels b. Depressed ST-segment on ECG and elevated total CPK c. Depressed ST-segment on ECG and normal cardiac enzymes d. Q wave on ECG with normal enzymes and troponin levels

a. ST-segment elevation on ECG and elevated CPK-MB ST-segment elevation and elevated cardiac enzymes are seen in Q wave MI

A patient presents to the ED complaining of severe substernal chest pressure radiating to his left shoulder and back that started about 16 hours ago. The patient delayed coming to the ED hoping the pain would go away. The patient's 12-lead ECG shows ST-segment depression in the inferior leads. Troponin and CK-MB are both elevated. The hospital does not have the capability for percutaneous coronary intervention. Thrombolysis is one possible treatment. Based on these data, the nurse correctly comes to what conclusion? a. The patient is not a candidate for thrombolysis b. The patient's history makes him a good candidate for thrombolysis c. Thombolysis is appropriate for a candidate having a non-Q wave MI d. Thrombolysis should be started immediately.

a. The patient is not a candidate for thrombolysis To be eligible for thrombolysis, the patient must be symptomatic for less than 12 hours

An adult patient suffered an anterior wall 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 failure b. papillary muscle rupture c. pericarditis d. pulmonary embolism

a. 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 symtpoms including difficulty in breathing, cyanosis, chest pain and possibly death.

The patient presents to the ED with severe substernal chest discomfort. Cardiac enzymes are elevated, and his ECG shows ST-segment depression in V2 and V2. The nurse anticipates and diagnosis of: a. non-Q-wave myocardial infarction b. pulmonary embolism c. Q-wave myocardial infarction d. right ventricular infarction

a. non-Q-wave myocardial infarction. 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

The patient's wife is feeling overwhelmed and tells the nurse that she doesn't know if she can manage to cook different dinners for her husband and the rest of the family to satisfy his cholesterol-reducing diet. The nurse should provide which response? a. "It will be worth it to have him healthy, won't it? b. "The low-cholesterol diet is one from which everyone can benefit. c. "As long as you change at least a few things in the diet, it will be okay. d. "You can go on the diet with him, and then just let the children eat whatever they want."

b. "The low-cholesterol diet is one from which everyone can benefit. Some cardiologists advocate a reduction of the LDL goal to the 50 - 70 mg/dL range for everyone, not only those with a known cardiovascular disease.

Which comment by the patient indicates a good understanding of the diagnosis of coronary heart disease? a. "I had a heart attack because I work too hard and it puts too much strain on my heart." b. "The pain in my chest gets worse each time it happens. I think that there is more damage to my heart vessels as time goes on." c. "If I change my diet and exercise more, I should get over this and be healthy." d. "What kind of pills can you give me to get over this and back to my lifestyle?"

b. "The pain in my chest gets worse each time it happens. I think that there is more damage to my heart vessels as time goes on." Coronary heart disease is a progressive atherosclerotic disorder of the coronary arteries that results in narrowing or complete occlusion.

Which nursing interventions would be appropriate after angioplasty? (Select all that apply.) a. Elevate the head of the bed by 45 degrees for 6 hours b. Assess pedal pulses on the involved limb every 15 minutes for 1 to 2 hours c. Monitor the vascular hemostatic device for signs of bleeding d. Instruct the patient to bend his or her knee every 15 minutes while the sheath is in place e. Maintain NPO status for 12 hours

b. Assess pedal pulses on the involved limb every 15 minutes for 1 to 2 hours c. Monitor the vascular hemostatic device for signs of bleeding The head of the bed must not be elevated more than 30 degrees, and the patient should be instructed to keep the affected leg straight. Bed rest is 6 to 8 hours in duration, unless a vascular hemostatic device is used. The nurse observes the patient for bleeding or swelling at the puncture site and frequently assesses adequacy of circulation to the involved extremity. NPO status does not need to be maintained after the patient is fully alert.

Which statements related to the management of unstable angina are true? (Select all that apply.) a. Aspirin is given at the onset of each chest pain episode b. Calcium channel blockers help to reduce symptoms c. Early revascularization (eg, angioplasty) may be helpful d. It is best treated with rest and nitroglycerin

b. Calcium channel blockers help to reduce symptoms c. Early revascularization (eg, angioplasty) may be helpful d. It is best treated with rest and nitroglycerin 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.

What aspect of teaching is essential in preventing recurrence of heart failure? a. Notifying the physician if a 2-lb weight gain occurs in 24 hours. b. Compliance with diuretic therapy c. Taking nitroglycerin is chest pain occurs d. Assessment of an apical pulse

b. Compliance with diuretic therapy Reduction of cessation of diuretics usually results in sodium and water retention, which may precipitate heart failure. None of the other options have the impact diuretic therapy has on managing heart failure.

A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patient's quality of life? a. Intraaortic balloon pump (IABP) b. Left ventricular assist device (LVAD) c. Nothing, because the patient is in terminal heart failure d. Nothing additional; medical management is the only option

b. Left ventricular assist device (LVAD) LVADs are capable of partial to complete circulatory support for short- to long-term use. At present, the LVAD is therapy for patients with terminal heart failure. It would provide better management than medical therapy alone. The IABP is for short-term management of acute heart failure.

The patient is admitted with an AMI. Three days later the nurse is concerned that the patient may have a papillary muscle rupture. Which assessment data may indicate a papillary muscle rupture? a. Gallop rhythm b. Murmur c. S1 heart sound d. S3 heart sound

b. Murmur The presence of a new murmur warrants special attention, particularly in a patient with an AMI. A papillary muscle may have ruptured, causing the calve to close incorrectly, which can be indicative of severe damage and impending complications.

The patient's wife asks the nurse if the angioplasty will remove all the buildup in the vessel walls so that the patient will be healthy again. What explanation should the nurse provide? a. "the operation will remove all of the plaque, and if your husband exercises and diets, he will be free of cardiac problems." b. "The surgery will remove all the buildup, but it will reaccumulate and he will probably need this surgery again this time next year." c. "The best outcome will be if 20% to 50% of the diameter of the vessel can be restored. Your husband will need to diet and exercise carefully to avoid further cardiac risk." d. "The surgeon will only be able to get 5% to 10% of the plaque, but this will bring about marked relief of your husband's symptoms."

c. "The best outcome will be if 20% to 50% of the diameter of the vessel can be restored. Your husband will need to diet and exercise carefully to avoid further cardiac risk." A successful angioplasty procedure is one in which the stenosis is reduced to less than 50% of the vessel lumen diameter, although most clinicians aim for less than 20% final diameter stenosis.

The patient presents to the ED with sudden severe sharp chest discomfort radiating to the back and down both arms, as well as numbness in the left arm. While taking the patient's vital signs, the nurse notices a 30-point discrepancy in systolic blood pressure between the right and left arm. Based on these findings, what should the nurse do in addition to informing the primary care provider? a. Report the cardiac enzyme results b. Prepare the patient for thrombolytic therapy c. Begin prepping the patient for emergency surgery d. Give the patient aspirin and heparin

c. Begin prepping the patient for emergency surgery These symptoms indicate the possibility of acute aortic dissection. Symptoms often mimic those of an AMI or pulmonary embolism. Aortic dissection is a surgical emergency. S/S include chest pain and arm paresthesia. The other options relate to cardiac issues.

While instructing a patient on what occurs with MI, the nurse plans to explain which process? a. Coronary artery spasm b. Decreased blood flow (ischemia) c. Death of cardiac muscle from lack of oxygen (tissue necrosis) d. Sporadic decrease in oxygen to the heart (transient oxygen imbalance)

c. Death of cardiac muscle from lack of oxygen (tissue necrosis) AMI is death (tissue necrosis) of the myocardium that is caused by lack of blood supply from the occlusion of a coronary artery and its branches

A patient diagnosed with coronary artery disease is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers? a. 12-lead electrocardiogram b. Cardiac catheterization c. Echocardiogram d. Electrophysiology study

c. Echocardiogram Echocardiography is a noninvasive, acoustic imaging procedure and involves the use of ultrasound to visualize the cardiac structures and the motion and function of cardiac valves and chambers.

A patient is admitted with an AMI. The nurse knows that ACE inhibitor should be started within 24 hours to reduce the incidence of which process? a. Myocardial stunning b. Hibernating myocardium c. Myocardial remodeling d. Tachycardia

c. Myocardial remodeling Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors reduce the incidence of remodeling.

A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated? a. ACE inhibitors and diuretics b. Morphine sulfate and oxygen c. Nitroglycerin, oxygen, and beta-blockers d. Statins, bile acid, and nicotinic acid

c. Nitroglycerin, oxygen, and beta-blockers Conservative intervention for the patient experiencing angina includes nitrates, beta-blockers and oxygen.

*A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following? a. Complete occlusion of a coronary artery b. Fatty streak within the intima of a coronary artery c. Partial occlusion of a coronary artery with a thrombus d. Vasospasm of a coronary artery

c. Partial occlusion of a coronary artery with a thrombus In unstable angina, some blood continues to flow through the affected coronary artery; however, flow is diminished related to partial occlusion. The pain in unstable angina is more sever, may occur at rest, and requires more frequent nitrate therapy.

The patient is admitted with recurrent supraventricular tachycardia that the cardiologist believes to be related to an accessory conduction pathway or a reentry pathway. The nurse anticipates which procedure to be planned for this patient? a. Implantable cardioverter-defibrillator placement b. Permanent pacemaker insertion c. Radiofrequency catheter ablation d. Temporary transvenous pacemaker placement

c. Radiofrequency catheter ablation Radiofrequency catheter ablation is a method of interrupting a supraventricular tachycardia, a dysrhythmia caused by a reentry circuit, and an abnormal conduction pathway.

A 72-year old woman is brought to the ED by her family. The family states that she's "just not herself." Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions (PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead ECG shows elevated ST segments in leads II, III, and AVF. The nurse knows that these symptoms are most likely associated with which diagnosis? a. Hypokalemia b. Non-Q wave MI c. Silent myocardial infarction d. Unstable angina

c. Silent myocardial infarction Some individuals may have ischemic episodes without knowing it, thereby having a "silent" infarction. These can occur with no presenting signs or symptoms. Asymptomatic or nontraditional symptoms are more common in elderly persons, in women, and in diabetic patients.

The primary care provider orders a pharmacological stress test for a patient with activity intolerance. The nurse would anticipate that the drug of choice would be a. dopamine b. dobutamine c. adenosine d. atropine

c. adenosine If a patient is unable physically to perform the exercise, a pharmacological stress test can be done. Adenosine is preferred over dobutamine because of its short duration of action and because reversal agents are not needed.

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. clopidogrel c. nicotinic acid d. statins

c. nicotinic acid Common side effects of nicotinic acid include metallic taste in mouth, flushing, and increased feelings of warmth

A patient is having an emergent coronary intervention, and the nurse is starting an infusion of abciximab. The patient asks what the purpose of this drug is. What response by the nurse is best? a. "This will help prevent chest pain until the intervention is complete." b. "This medication dries oral and respiratory secretions during the procedure." c. "This is a mild sedative and amnesic agent, so you'll be very relaxed." d. "This drug helps prevent blood clotting and is often used for this procedure."

d. "This drug helps prevent blood clotting and is often used for this procedure." Abciximab is glycoprotein IIb/IIIc inhibitor and antiplatelet agent. It is used to prevent clotting in acute coronary syndromes and coronary intervention patients.

Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery? a. Right coronary artery b. Left coronary artery c. Circumflex d. Left main coronary artery

d. Left main coronary artery Stenosis of the left mainstem artery is considered unacceptable for percutaneous intervention.

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. Metoprolol c. Nifedipine d. Nitroglycerin sublingual

d. Nitroglycerin sublingual These are symptoms of angina. Administration of nitrates is indicated as a first-line treatment.

A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient? a. Bile acid resins b. Nicotinic acid c. Nitroglycerin d. Statins

d. Statins The statins have been found to lower LDLs more than other types of lipid-lowering drugs.

The nurse is caring for a patient who has symptoms of an AMI. Which lab should the nurse prepare to draw in order to detect myocardial necrosis? a. CK b. CK-MB c. Potassium d. Troponin I

d. Troponin I Troponin I has a greater specificity than other tests in the diagnosis of AMI at 7 to 14 hours after the onset of chest pain.

A patient presents to the ED with chest pain occurring for the past 2 hours. The patient is nauseous and diaphoretic with skin that is dusky in color. The electrocardiogram shows ST elevation in leads II, III, and a VF. Which therapeutic intervention would the nurse question? a. Emergent pacemaker insertion b. Emergent percutaneous coronary intervention c. Emergent thrombolytic therapy d. Immediate coronary artery bypass graft surger

a. Emergent pacemaker insertion The goals of management of AMI are to dissolve the lesion that is occluding the coronary artery and to increase blood flow to the myocardium. Options include emergent percutaneous intervention, such as angioplasty, emergent coronary artery bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for less than 6 hours. No data in this scenario warrant insertion of a pacemaker.

The patient's wife is confused about the scheduling of a stent insertion. She says that she thought the angioplasty was surgery to fix her husband's heart problem. The nurse should provide what explanation to her? a. "The angioplasty was a failure, and so this procedure has to be done to fix the heart vessel." b. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again." c. "This procedure is being done instead of using clot-dissolving medication to help keep the heart vessel open." d. "The stent will remove any clots that are in the vessel and protect the heart muscle from damage."

b. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again." Stents are inserted to optimize the results of other treatments for acute vessel closure (PTCA, atherectomy, fibrinolytics) and to prevent restenosis.