MI
A client with myocardial infarction is experiencing new, multiform premature ventricular contractions and short runs of ventricular tachycardia. The nurse plans to have which medication available for immediate use to treat the ventricular tachycardia? Digoxin Verapamil Acebutolol Amiodarone
Amiodarone Amiodarone is an antidysrhythmic that may be used to treat ventricular dysrhythmias. Digoxin is a cardiac glycoside; verapamil is a calcium channel-blocking agent; acebutolol is a beta-adrenergic blocking agent. Digoxin can be used to treat supraventricular dysrhythmias but is inactive against ventricular dysrhythmias. Verapamil is used to slow the ventricular rate for a client with atrial fibrillation or atrial flutter, or to terminate supraventricular tachycardia. Acebutolol is a beta blocker used to treat dysrhythmias.
A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer? Ad lib activities as tolerated Strict bed rest for 24 hours after transfer Bathroom privileges and self-care activities Unsupervised hallway ambulation for distances up to 200 feet (60 meters)
Bathroom privileges and self-care activities On transfer from CCU to an intermediate care or general medical unit, the client is allowed self-care activities and bathroom privileges. Activities ad lib as tolerated is premature at this time and potentially harmful for this client. It is unnecessary and possibly harmful to limit the client to bed rest. The client should ambulate with supervision in the hall for brief distances, with the distances being gradually increased to 50, 100, and 200 feet (15, 30, and 60 meters).
The home health nurse is visiting an older client whose family has gone out for the day. During the visit, the client experiences chest pain that is unrelieved by sublingual nitroglycerin tablets given by the nurse. Which action by the nurse would be appropriate at this time? Notify a family member who is the next of kin. Drive the client to the primary health care provider's (PHCP's) office. Inform the home care agency supervisor that the visit may be prolonged. Call for an ambulance to transport the client to the hospital emergency department.
Call for an ambulance to transport the client to the hospital emergency department. Chest pain that is unrelieved by rest and nitroglycerin might not be typical anginal pain but may signal myocardial infarction (MI). Because the risk of sudden cardiac death is greatest in the first 24 hours after MI, it is imperative that the client receive emergency cardiac care. Communication with the family or home care agency delays client treatment, which is needed immediately. The PHCP's office is not equipped to treat MI.
A client is admitted to the hospital with a diagnosis of myocardial infarction (MI). The client is started on alteplase therapy. The nurse determines that teaching has been effective when the client's significant other states that the purpose of the medication is to perform which action? Thin the blood. Slow the clotting of the blood. Dissolve any clots in the coronary arteries. Prevent further clots from forming in the coronary arteries.
Dissolve any clots in the coronary arteries. Alteplase converts plasminogen in the blood to plasmin. Plasmin is an enzyme that digests or dissolves fibrin clots wherever they exist. Heparin sodium and warfarin sodium thin the blood, slow clotting, and prevent further clots from forming.
A client is diagnosed with an ST segment elevation myocardial infarction (STEMI) and is receiving a tissue plasminogen activator, alteplase. Which action is a priority nursing intervention? Monitor for kidney failure. Monitor psychosocial status. Monitor for signs of bleeding. Have heparin sodium available.
Monitor for signs of bleeding. Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.
The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit (ICU). The nurse notes that a cardiac troponin T assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition? Heart failure Atrial fibrillation Myocardial infarction Ventricular tachycardia
Myocardial infarction Cardiac troponin T or cardiac troponin I have been found to be a protein marker in the detection of myocardial infarction, and assay for this protein is used in some institutions to aid in the diagnosis of a myocardial infarction. The test is not used to diagnose heart failure, ventricular tachycardia, or atrial fibrillation.
A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as an indicator that the client is experiencing complications of this therapy? Tarry stools Nausea and vomiting Orange-colored urine Decreased urine output
Tarry stools Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood.
A client is seen in the emergency department for complaints of chest pain that began 3 hours ago. The nurse should suspect myocardial injury or infarction if which laboratory value comes back elevated? Troponin Myoglobin C-reactive protein Creatine kinase (CK)
Troponin Cardiac troponin elevations indicate myocardial injury or infarction. Although the remaining options may also rise, they are not definitive enough to draw a conclusive diagnosis.
The client who has experienced a myocardial infarction (MI) is recovering from cardiogenic shock. The nurse knows that which observation of the client's clinical condition is most favorable? Urine output of 40 mL/hr Heart rate of 110 beats/minute Frequent premature ventricular contractions Central venous pressure (CVP) of 15 mm Hg
Urine output of 40 mL/hr Urine output of greater than 30 mL/hr indicates adequate perfusion to the kidneys, so the other organs are most likely equally perfused. Classic cardiovascular signs of cardiogenic shock include low blood pressure and tachycardia. Dysrhythmias commonly occur as a result of decreased oxygenation to the myocardium and are not a favorable sign. The CVP rises as the effects of the backward blood flow caused by the left ventricular failure become apparent.
A client is admitted to the emergency department with a diagnosis of myocardial infarction (MI). The primary health care provider (PHCP) prescribes the administration of alteplase. The registered nurse (RN) preceptor is orienting a new RN in the use of this medication. Which statement by the new RN indicates that teaching has been effective? "Administer the medication within 4 to 6 hours after onset of chest pain." "Administer the medication concurrently with the administration of heparin." "Administer the medication with the administration solution set protected from light." "Administer the medication after the results of all laboratory tests have been received."
"Administer the medication within 4 to 6 hours after onset of chest pain." Alteplase is a fibrinolytic medication. In a client with an acute coronary artery thrombosis that evolves into a transmural MI, fibrinolytic therapy is most effective when started within 4 to 6 hours after onset of symptoms. The solution does not need to be protected from light. Heparin may be administered after the administration of alteplase but not concurrently, and it is not appropriate to wait for all laboratory tests to administer the medication.
The nurse has just completed education on myocardial infarction (MI) to a group of new nurses. Which statement made by one of the nurses indicates that the teaching has been effective? "Chest pain is caused by tissue hypoxia in the myocardium." "Chest pain is caused by tissue hypoxia in the vessels of the heart." "Chest pain is caused by tissue hypoxia in the parietal pericardium." "Chest pain is caused by tissue hypoxia in the visceral pericardium."
"Chest pain is caused by tissue hypoxia in the myocardium." The myocardial layer of the heart is damaged when a client experiences an MI. This is the middle layer that contains the striated muscle fibers responsible for the contractile force of the heart. The obstruction, which causes the interruption in blood flow and ensuing hypoxia, affects the myocardial layer. The endocardium is the thin inner layer of cardiac tissue. The parietal pericardium and visceral pericardium are outer layers that protect the heart from injury and infection.
The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge? "I need to start exercising more to improve my health." "I will be sure to keep my appointment with the cardiologist." "I don't have anyone to help me with doing heavy housework at home." "I think I have a good understanding of what all my medications are for."
"I don't have anyone to help me with doing heavy housework at home." To ensure the best outcome, clients should be able to comply with instructions related to activity, diet, medications, and follow-up health care on discharge from the hospital after an MI. All of the options except the correct one indicate that the client will be successful in these areas.
The home health nurse visits a client recovering after an episode of cardiogenic shock secondary to an anterior myocardial infarction (MI) and provides home care instructions to the client. Which statement by the client indicates an understanding of these home care measures? "I exercise every day after breakfast." "I've gained 8 lb (3.6 kg) since discharge." "I take an antacid when I experience epigastric pain." "I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily."
"I have planned periods of rest at 10:00 a.m. and 3:00 p.m. daily." The client recovering from an episode of cardiogenic shock secondary to an MI will require a progressive rehabilitation related to physical activity. The heart requires several months to heal from an uncomplicated MI. The complication of cardiogenic shock increases the recovery period for healing. Paced activities with planned rest periods will decrease the chance of experiencing angina or delayed healing. It is best to allow the meal to settle prior to activity in order to improve circulation to the heart during exercise. Epigastric pain or a weight gain of 8 lb (3.6 kg) is significant and should be reported to the primary health care provider, at which point follow-up should occur.
The nurse has provided instructions to a client who will receive alteplase for the treatment of acute myocardial infarction. The nurse determines that teaching was effective if the client states that the main action of alteplase is what? "It will slow the clotting of my blood." "It will keep my blood thin to prevent clotting." "It will dissolve any clots that are obstructing the coronary arteries." "It will prevent any further clots from forming anywhere in the body."
"It will dissolve any clots that are obstructing the coronary arteries." Alteplase is a thrombolytic medication that is used to manage acute myocardial infarction. It lyses thrombi that are obstructing the coronary arteries, decreases infarct size, improves ventricular function, decreases the risk of heart failure, and limits the risk of death associated with myocardial infarction. Options 1, 2, and 4 are not actions of this medication.
The nurse is making an initial home visit to a client who was recently discharged from the hospital after treatment for a myocardial infarction. The nurse should use which type of database initially to obtain information from the client? An episodic database A follow-up database An emergency database A complete health database
A complete health database A complete health database is the framework for a complete health history and full physical examination. The information thus obtained describes the current and past health state and forms a baseline against which all future changes can be measured. The complete health database is used in a primary care setting, such as a pediatric or family practice clinic, independent or group private practice, college health service, women's health care agency, visiting nurse agency, or community health agency. An episodic database is used for a limited or short-term problem. It focuses mainly on 1 problem or 1 body system. A follow-up database evaluates an identified problem at regular and appropriate intervals. An emergency database is used for rapid collection of the data, often compiled concurrently with lifesaving measures.
A client who is experiencing an inferior wall myocardial infarction has had a drop in heart rate into the range of 50 to 56 beats/minute. The client also is complaining of nausea. On the basis of these findings, the nurse determines that the client is experiencing parasympathetic stimulation of which cranial nerve? Vagus (CN X) Hypoglossal (CN XII) Spinal accessory (CN XI) Glossopharyngeal (CN IX)
Vagus (CN X) The vagus nerve is responsible for sensations in the thoracic and abdominal viscera. It also is responsible for the decrease in heart rate because approximately 75% of all parasympathetic stimulation is carried by the vagus nerve. CN XII is responsible for tongue movement. CN XI is responsible for neck and shoulder movement. CN IX is responsible for taste in the posterior two-thirds of the tongue, pharyngeal sensation, and swallowing.
A client hospitalized with a diagnosis of myocardial infarction calls for the unit nurse because the client is experiencing chest pain. The nurse administers a sublingual nitroglycerin tablet as prescribed. The client, who is receiving oxygen by nasal cannula, reports that her chest pain is unrelieved by the nitroglycerin. Which is the next nursing action for this client? Call the client's family. Increase the flow rate of oxygen. Contact the primary health care provider (PHCP). Administer another nitroglycerin tablet.
Administer another nitroglycerin tablet. For the hospitalized client, nitroglycerin tablets are administered 1 tablet every 5 minutes, for a total of 3 tablets per episode of chest pain, as long as the client maintains a systolic blood pressure of 100 mm Hg or higher. Increasing the flow rate of oxygen may be prescribed by the PHCP but would not be the next nursing action. If 3 nitroglycerin tablets do not relieve the client's chest pain, the PHCP needs to be notified. It is premature to call the client's family.
A client having a myocardial infarction is receiving alteplase therapy. Which action should be carried out by the nurse to monitor for the most frequent side/adverse effect? Check for signs of bleeding. Assess for allergic reaction. Evaluate the client for muscle weakness. Monitor for signs and symptoms of infection.
Check for signs of bleeding. Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots; therefore, bleeding is a concern. Allergic reaction is not a frequent response. Muscle weakness is not a side/adverse effect of this medication. Local or systemic infection could occur with poor aseptic technique during medication administration, but it is rare and not specifically associated with this medication.
A client is brought to the emergency department complaining of substernal chest pain. To distinguish between angina and myocardial infarction, the nurse assesses for which characteristics of angina? Select all that apply. Chest pain that resolves with rest Chest pain requiring an opioid for relief Chest pain that is relieved by nitroglycerin Chest pain that lasts longer than 30 minutes Chest pain that is usually precipitated by exertion
Chest pain that resolves with rest Chest pain that is relieved by nitroglycerin Chest pain that is usually precipitated by exertion Angina is chest pain caused by a temporary imbalance between the coronary arteries' ability to supply oxygen and the cardiac muscle's demand for oxygen. Myocardial infarction refers to injury and necrosis of myocardial tissue that occurs when the tissue is abruptly and severely deprived of oxygen. When a client complains of chest pain, it is critical that treatment is immediately initiated and that the nurse assesses for characteristics of angina versus those associated with myocardial infarction. Angina is characterized by substernal chest pain radiating to the left arm. The pain is usually precipitated by exertion or stress, is relieved by nitroglycerin or rest, and lasts less than 15 minutes. Characteristics of myocardial infarction include substernal chest pain that radiates to the left arm; pain in the jaw, abdomen, back, or shoulder can also occur. The substernal chest pain occurs without cause, usually in the morning; is relieved only by opioids; and lasts 30 minutes or longer.
A client with the recent diagnosis of myocardial infarction and impaired renal function is recuperating on the cardiac step-down unit. The client's blood pressure has been borderline low, and intravenous (IV) fluids have been infusing at 100 mL/hour via a central line catheter in the right internal jugular vein for approximately 24 hours to increase renal output and maintain the blood pressure. Upon entering the client's room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is most likely experiencing which complication of IV therapy? Hematoma Air embolism Systemic infection Circulatory overload
Circulatory overload Circulatory (fluid) overload is a complication of IV therapy. Signs include rapid breathing, dyspnea, a moist cough, and crackles. When circulatory overload is present, the client's blood pressure also increases. Hematoma is characterized by ecchymosis, swelling, and leakage at the IV insertion site, as well as hard and painful lumps at the site. Air embolism is characterized by tachycardia, dyspnea, hypotension, cyanosis, and decreased level of consciousness. Systemic infection is characterized by chills, fever, malaise, headache, nausea, vomiting, backache, and tachycardia.
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds? Stridor Crackles Scattered rhonchi Diminished breath sounds
Crackles Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Rhonchi and diminished breath sounds are not associated with pulmonary edema. Stridor is a crowing sound associated with laryngospasm or edema of the upper airway.
A client who has had a myocardial infarction has a prescription to take a powdered form of psyllium after discharge. The nurse should plan to include which information when teaching the client about this medication? Mix the medication with applesauce. Mix the medication with a full glass of water or juice. Decrease fluid intake following administration of the medication. Decrease the amount of fiber in the diet when taking this medication.
Mix the medication with a full glass of water or juice. Psyllium is a bulk-forming laxative that should be taken with a full glass of water or juice (not applesauce), followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. Fiber in the diet and fluid intake should not be decreased unless specifically prescribed by the primary health care provider.
A client is admitted to the hospital with a diagnosis of myocardial infarction (MI) and is going to have an intravenous (IV) nitroglycerin infusion started. Noting that the client does not have an intra-arterial monitoring line in place, what piece of equipment should the nurse obtain for use at the bedside? Defibrillator Pulse oximeter Noninvasive blood pressure monitor Central venous pressure (CVP) insertion tray
Noninvasive blood pressure monitor Nitroglycerin dilates both arteries and veins, causing peripheral blood pooling, thereby reducing preload, afterload, and myocardial work. This also accounts for the primary side effect of nitroglycerin, which is hypotension. In the absence of continuous direct arterial pressure (intra-arterial) monitoring, the nurse should use an automatic noninvasive blood pressure monitor. The remaining options are not specifically associated with the administration of IV nitroglycerin.
A client is admitted to a hospital with acute myocardial infarction and is started on tissue plasminogen activator (tPA) by infusion. Which parameter should the nurse determine requires the least frequent assessment to detect complications of therapy with tPA? Neurological signs Blood pressure and pulse Presence of bowel sounds Complaints of abdominal and back pain
Presence of bowel sounds Thrombolytic agents dissolve existing clots, and bleeding can occur anywhere in the body. The nurse monitors for any obvious signs of bleeding and also for occult signs of bleeding, which would include hemoglobin and hematocrit values, blood pressure and pulse, neurological signs, assessment of abdominal and back pain, and the presence of blood in the urine or stool.
The nurse is caring for a client with a diagnosis of myocardial infarction (MI). The client is experiencing chest pain that is unrelieved by the administration of nitroglycerin. The nurse administers morphine sulfate to the client as prescribed by the primary health care provider. After administration of the morphine sulfate, what is the priority assessment? Respirations Mental status Urinary output Blood pressure
Respirations Morphine sulfate is an opioid analgesic that may be administered to relieve pain in a client with MI. The nurse would monitor the client's respirations and blood pressure. Signs of morphine toxicity include respiratory depression and hypotension. Respiratory depression is the priority concern using the ABCs - airway, breathing, and circulation - assessment. Although monitoring mental status is a component of the nurse's assessment, it is not the priority after administration of morphine sulfate. Urinary output is unrelated to the administration of this medication. Monitoring the temperature also is not associated with the use of this medication.
The post-myocardial infarction client is scheduled for a technetium-99m ventriculography (multigated acquisition [MUGA] scan). The nurse ensures that which item is in place before the procedure? A urinary catheter Signed informed consent A central venous pressure (CVP) line Notation of allergies to iodine or shellfish
Signed informed consent MUGA is a radionuclide study used to detect myocardial infarction and decreased myocardial blood flow and to determine left ventricular function. A radioisotope is injected intravenously; therefore, a signed informed consent is necessary. A urinary catheter and CVP line are not required. The procedure does not use radiopaque dye; therefore, allergies to iodine and shellfish are not a concern.
The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding? The client is not experiencing dyspnea. The client is not experiencing nausea or vomiting. The pain has not been relieved by rest and nitroglycerin tablets. The client says the pain began while she was trying to open a stuck dresser drawer.
The pain has not been relieved by rest and nitroglycerin tablets. The pain of MI is not relieved by rest and nitroglycerin and requires opioid analgesics, such as morphine sulfate, for relief. The pain of angina may radiate to the left shoulder, arm, neck, or jaw. It often is precipitated by exertion or stress, is accompanied by few associated symptoms, and is relieved by rest and nitroglycerin. The pain of MI also may radiate to the left arm, shoulder, jaw, and neck. It typically begins spontaneously, lasts longer than 30 minutes, and frequently is accompanied by associated symptoms (i.e., nausea, vomiting, dyspnea, diaphoresis, or anxiety).
A thrombolytic is administered in the hospital emergency department to a client who has had a myocardial infarction. The client's spouse asks the nurse about the purpose of the medication. The nurse bases the response on which fact regarding this medication? Thrombolytics suppress the production of fibrin. Thrombolytics act to prevent thrombus formation. Thrombolytics act to dissolve thrombi that have already formed. Thrombolytics have been proved to reverse all detrimental effects of heart attacks.
Thrombolytics act to dissolve thrombi that have already formed. Thrombolytics are most effective when started within 4 to 6 hours after symptom onset and act to dissolve or lyse existing thrombi that are causing a blockage. The remaining options are incorrect.
The nurse is caring for a client just admitted to the critical care unit with a diagnosis of myocardial infarction (MI). In the early period after an MI, why are nutrition interventions and education so important? Select all that apply. To reduce angina To cut down on cardiac workload To decrease the risk of dysrhythmias To cause weight loss in obese clients To cut down on the cost of a hospital stay To eliminate further deterioration of kidney function
To reduce angina To cut down on cardiac workload To decrease the risk of dysrhythmias In the early period after an MI, nutrition interventions and education are designed to reduce angina, cardiac workload, and risk of dysrhythmia. Nutrition interventions and education do not cut down on the cost of a hospital stay or prevent problems with kidney function. Although weight loss in obese clients is an intervention, this is not so important to address in the early period following an MI. Meal size, caffeine intake, and food temperatures are some of the dietary factors that are of concern. Small, frequent snacks are preferable to larger meals for clients with severe myocardial compromise or postprandial angina. If caffeine is included in the diet, its effects should be monitored. Caffeine is a stimulant and may increase heart rate and myocardial oxygen demand. Very hot or very cold foods should be avoided because they potentially can trigger vagal or other neural input and cause cardiac dysrhythmias.
A client who is experiencing an inferior wall myocardial infarction has had a drop in heart rate into the 50 to 56 beats/minute range. The client is also complaining of nausea. Which cranial nerve damage should the nurse expect that the client is experiencing? Vagus (CN X) Hypoglossal (CN XII) Spinal accessory (CN XI) Glossopharyngeal (CN IX)
Vagus (CN X) The vagus nerve is responsible for sensations in the thoracic and abdominal viscera. It is also responsible for the decrease in heart rate because approximately 75% of all parasympathetic stimulation is carried by the vagus nerve. CN IX is responsible for taste in the posterior two-thirds of the tongue, pharyngeal sensation, and swallowing. CN XI is responsible for neck and shoulder movement. CN XII is responsible for tongue movement.
A client with myocardial infarction is developing cardiogenic shock. Because of the risk of myocardial ischemia, what condition should the nurse carefully assess the client for? Bradycardia Ventricular dysrhythmias Rising diastolic blood pressure Falling central venous pressure
Ventricular dysrhythmias Classic signs of cardiogenic shock as they relate to myocardial ischemia include low blood pressure and tachycardia. The central venous pressure would rise as the backward effects of the severe left ventricular failure became apparent. Dysrhythmias commonly occur as a result of decreased oxygenation and severe damage to greater than 40% of the myocardium.
