Dysrhythmias/Myocardial Infarction/Angina
A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider? A. Generalized muscle aches and pains B. Dizziness with rapid position changes C. Nausea when taking the drugs before meals D. Flushing and pruritus after taking the drugs
A
A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. Which response by the nurse is best? "Most patients are able to enjoy intercourse without any complications." "Sexual activity uses about as much energy as climbing two flights of stairs." "The doctor will provide sexual guidelines when your heart is strong enough." "Holding and cuddling are good ways to maintain intimacy after a heart attack."
B
The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. What task should the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? A. Teach the patient about the postprocedure plan of care. B. Give the scheduled aspirin and lipid-lowering medication. C. Perform the initial assessment of the catheter insertion site. D. Titrate the heparin infusion according to the agency protocol.
B
The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. What should teaching for this patient include today? A. Typical emotional responses to AMI B. When cardiac rehabilitation will begin C. Pathophysiology of coronary artery disease D. Information regarding discharge medications
B
Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is mostimportant for the nurse to communicate to the health care provider? A. Complaints of incisional chest pain B. Pallor and weakness of the right hand C. Fine crackles heard at both lung bases D. Redness on both sides of the sternal incision
B
Which patient at the cardiovascular clinic requires the most immediate action by the nurse? A. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL. B. Patient with stable angina whose chest pain has recently increased in frequency. C. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL. D. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg.
B
A patient with diabetes mellitus and chronic stable angina has a new order for captopril. What should the nurse teach this patient about the primary purpose of captopril? A. Decreases the heart rate. B. Controls blood glucose levels. C. Prevents changes in heart muscle. D. Reduces the frequency of chest pain.
C
Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective? A. "I can expect nausea as a side effect of nitroglycerin." B. "I should only take nitroglycerin when I have chest pain." C. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart." D. "I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart."
D
A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Reinforcement of teaching about the prescribed medications B. Evaluation of the patient's response to walking in the hallway C. Completion of the referral form for a home health nurse follow-up D. Education of the patient about the pathophysiology of heart disease
A
After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? "What do you think caused your chest pain?" "Where are you planning to go for your vacation?" "Sometimes plans need to change after a heart attack." "Recovery from a heart attack takes at least a few weeks."
A
When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? A. Attach the heart monitor. B. Obtain the blood pressure. C. Assess the peripheral pulses. D. Auscultate the breath sounds.
A Because dysrhythmias are the most common complication of myocardial infarction (MI), the first action should be to place the patient on a heart monitor. The other actions are also important and should be accomplished as quickly as possible.
After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? A. Hyperglycemia B. Bilateral crackles C. Q waves on ECG D. Elevated troponin
B
The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from an acute myocardial infarction? A. The pain increases with deep breathing. B. The pain has lasted longer than 30 minutes. C. The pain is relieved after the patient takes nitroglycerin. D. The pain is reproducible when the patient raises the arms.
B
A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one should the nurse arrange to be completed first? A. Chest x-ray B. Troponin level C. Electrocardiogram (ECG) D. Insertion of a peripheral IV
C
The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? A. The troponin level is elevated. B. The patient denies having a heart attack. C. Bilateral crackles in the mid-lower lobes. D. Occasional premature atrial contractions (PACs).
C
The nurse reviews information shown in the accompanying figure from the medical records of a 43-year-old patient. Which risk factor modification for coronary artery disease should the nurse include in patient teaching? A. Importance of daily physical activity B. Effect of weight loss on blood pressure C. Dietary changes to improve lipid levels D. Cardiac risk associated with previous tobacco use
C
Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? A. An increase in troponin levels from baseline B. A large bruise at the patient's IV insertion site C. No change in the patient's reported level of chest pain D. A decrease in ST-segment elevation on the electrocardiogram
C Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention may be needed. Bruising is a possible side effect of thrombolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring, and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac biomarkers into the circulation as the blocked vessel is opened.
Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider? A. Inverted P wave B. Sinus tachycardia C. ST-segment elevation D. First-degree atrioventricular block
C The patient is likely to be experiencing an ST-segment-elevation myocardial infarction. Immediate therapy with percutaneous coronary intervention or thrombolytic medication is indicated to minimize myocardial damage. The other ECG changes may also suggest a need for therapy but not as rapidly.
A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse? A. Report of chest pain B. Heart rate 102 beats/min C. Pedal pulses 1+ bilaterally D. Blood pressure 103/54 mm Hg
C The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse.
After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? A. A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain. B. A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia). C. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. D. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).
D After PCI, the patient is at risk for hemorrhage from the arterial access site. The nurse should assess the patient's blood pressure, pulses, and the access site immediately. The other patients should also be assessed as quickly as possible, but assessment of this patient has the highest priority.
A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority? A. Anxiety B. Acute pain C. Stress management D. Decreased cardiac output
D The hypotension and tachycardia indicate decreased cardiac output and shock from the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g., brain, kidney, heart) and is a priority.
Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? A. "The pain wakes me up at night." B. "The pain is level 3 to 5 (0 to 10 scale)." C. "The pain has gotten worse over the last week." D. "The pain goes away after a nitroglycerin tablet."
d
