Lemone 30

The nurse suspects that a patient experienced a transmural myocardial infarction. What electrocardiogram finding did the nurse use to make this clinical decision? 1. Q wave deepening 2. ST segment elevation 3. ST segment depression 4. P wave inversion

Correct Answer: 1 A significant Q wave develops with a transmural infarction, so this also may be called a Q-wave MI. ST segment elevation represents myocardial ischemia, which is reversible by increasing the blood flow to the heart. ST segment depression occurs when muscle ischemia involves only a portion of the heart wall. P wave inversion represents a junctional pacemaker in the heart and is not related to changes that occur with a myocardial infarction.

The nurse is conducting teaching about risk factor management for cardiovascular disease (CVD) at a senior center. What is the most important information for the nurse to include? 1. Stop smoking. 2. Eat in moderation. 3. Exercise when able. 4. Reduce saturated fats in the diet.

Correct Answer: 1 Cigarette smoking is the leading independent risk factor for coronary heart disease. Diet and exercise management are important but not as significant a factor as smoking.

A patient is in sinus tachycardia. Which nursing interventions are appropriate? Standard Text: Select all that apply. 1. Observe the patient for effects on cardiac function. 2. Administer two tablets of acetaminophen (Tylenol) per physician prescription if an elevated temperature is present. 3. Administer normal saline 0.9% IV at the prescribed rate of 200 mL per hour if hypovolemia is suspected as the cause. 4. Give pain medications as prescribed if pain is present. 5. Give atropine per physician prescription to slow the heart rate.

Correct Answer: 1, 2, 3, 4 Appropriate nursing interventions for the patient in sinus tachycardia are to observe the patient for effects on cardiac function and to treat fever, hypovolemia, and pain if present. The focus is on determining the patient response to the elevated heart rate and treating the underlying causes, which are often fever, pain, and hypovolemia. Atropine acts to increase heart rate and may be a cause of sinus tachycardia.

The family of a patient who experienced a stroke after percutaneous coronary revascularization asks the nurse what caused the stroke to occur. How should the nurse respond to the family? 1. "A stroke could have been caused by clot particles from the procedure." 2. "Stroke is usually caused by ruptured plaque inside the coronary artery." 3. "Stroke is caused by heart failure." 4. "No one knows what causes strokes."

Correct Answer: 1 After percutaneous coronary revascularization clot particles can migrate leading to a stroke. Plaque inside a coronary artery would travel downstream and lodge in a smaller vessel in the heart. Heart failure does not cause a stroke. Stating that no one knows what causes strokes is not a true statement; blood clots and ruptured vessels cause strokes.

A 52-year-old obese male patient who is admitted with elevated triglycerides and a history of smoking two packs of cigarettes a day for 20 years asks about his risk for coronary artery disease. What information should the nurse provide? 1. He is at risk for coronary artery disease. 2. He is not at risk for coronary artery disease. 3. He has nothing but nonmodifiable risk factors for coronary artery disease. 4. He has nothing but modifiable risk factors for coronary artery disease.

Correct Answer: 1 Age is a nonmodifiable risk factor, while obesity, elevated triglycerides, and smoking are modifiable risk factors. Together, the risk factors place the patient at higher risk to develop coronary artery disease.

The patient has a pacemaker with one pacing spike seen on the ECG before every QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes the patient has what type of pacemaker? 1. asynchronous pacing 2. demand pacing 3. dual-chamber pacing 4. atrial single-chamber pacing

Correct Answer: 1 Asynchronous pacing delivers a pacing stimulus at a set rate regardless of intrinsic cardiac activity. A demand pacemaker spike varies with the heart rate. A dual-chamber pacer normally produces two pacing spikes, one before the P wave and one before the QRS. An atrial pacer would produce a spike, normally with a P wave that follows it prior to the QRS.

Fifteen hours after admission, a patient's CK-MB level is markedly increased. What should this indicate to the treatment team? 1. Cellular necrosis of myocardial tissue has occurred. 2. Lactic acid is present. 3. Thrombolytic therapy is indicated. 4. Cardiac function has returned to normal.

Correct Answer: 1 CK-MB is the intracellular enzyme that is released when cell damage and death occur. CK-MB becomes elevated when myocardial cell death has occurred. The pH is the indicator of lactic acid buildup. Thrombolytic therapy is indicated within the first 12 hours after symptoms develop, thus, it is too late for this intervention. Cardiac function has not returned to normal.

While caring for a patient admitted with chest pain, the nurse recognizes that what factor places the patient at the highest risk for heart disease? 1. overweight and carries the weight around the waist 2. mother died at age 70 of an acute myocardial infarction 3. a single mother of four young children with a low income 4. has a desk job and works long hours

Correct Answer: 1 Central obesity, or intra-abdominal fat, is associated with an increased risk for CHD. If the patient's mother had died before age 55, that would be a risk factor. Being a single mother is not a specific risk factor for the development of CAD. Sedentary life style is a risk factor, but not as significant as fat accumulation in the upper body.

The nurse is reviewing a new prescription for propranolol (Inderal) for a patient with coronary heart disease (CHD). The nurse should call the physician and question this prescription if the patient's history includes what information? 1. asthma and chronic obstructive pulmonary disease (COPD) 2. taking antioxidants 3. taking simvastatin (Zocor) 4. bleeding disorders

Correct Answer: 1 Class II beta-blockers such as propranolol are used to reduce heart rate and myocardial contractility and in the treatment of supraventricular tachycardia. These drugs may cause bronchospasm and are contraindicated for patients with asthma, chronic obstructive pulmonary disease (COPD), or other restrictive or obstructive lung diseases. Antioxidants and simvastatin may be taken concurrently with propranolol. Bleeding disorders are not associated with propranolol use.

A patient reports the following symptoms to the nurse: nausea, loss of appetite, blurred and double vision, green yellow halos, vomiting and "feeling uneasy." What situation should the nurse suspect? 1. digoxin toxicity 2. lidocaine toxicity 3. amiodarone toxicity 4. procainamide toxicity

Correct Answer: 1 Classic symptoms of digoxin toxicity include anorexia, nausea, vomiting, blurred or double vision, yellow green halos, and new-onset dysrhythmias. Lidocaine toxicity is manifested by changes in neurologic status; amiodarone toxicity is manifested by altered hepatic function, pulmonary fibrosis and photosensitivity; procainamide toxicity is manifested by flu-like symptoms, skin rash and signs of heart failure.

During a follow-up appointment after a myocardial infarction, a patient states, "My friends tell me to add more garlic to my diet and start drinking red wine each evening." What response by the nurse is best? 1. "Discuss your idea with the physician to see what would benefit you." 2. "That sounds fine. See how they work." 3. "I wouldn't do that if I were you." 4. "You should also add ginkgo biloba for cardiovascular health."

Correct Answer: 1 Complimentary therapies could be helpful. They should be added only after discussion with a healthcare provider who is familiar with the patient's history and current medication/allergy list. Interactions between herbal preparations and prescribed medications are common. Since the patient has taken an interest in her health by discussing it with her friends, ignoring her comment or discouraging her would not be beneficial. The nurse should not add or approve any other complimentary therapies unless directed so by the physician.

A patient received an implantable cardioverter-defibrillator (ICD). The nurse includes what instruction during discharge teaching for this patient? 1. "If a family member is in direct contact with you when the ICD discharges, he or she may experience a shock or tingling sensation." 2. "You can activate the ICD whenever you feel a change in your heart rhythm." 3. "The batteries of the ICD won't need to be replaced if the ICD never shocks the heart." 4. "There should be no discomfort if the ICD discharges, and you probably won't notice it."

Correct Answer: 1 Family members may receive a shock or tingling sensation when in direct contact with an individual when their ICD discharges. The ICD is programmed to automatically activate when detecting a potentially lethal cardiac rhythm and cannot be activated by the patient. Batteries must be surgically replaced every five years or following manufacturer's instructions. Some patients experience significant discomfort with ICD discharge.

The nurse is caring for a patient recovering from fibrinolytic therapy. For which common complication should the nurse focus care for this patient? 1. bleeding 2. hypotension 3. lethargy 4. heart block

Correct Answer: 1 Hemorrhage or bleeding is the most common complication; it can be life-threatening. Hypotension can occur, but it is not the most common complication. Lethargy and heart block are not associated with fibrinolytic therapy.

Aspirin has been prescribed for a patient following a myocardial infarction. What should the nurse include when teaching about this drug? 1. Check with your healthcare provider before taking any herbal remedies. 2. Report any itching that develops after seven days of taking the drug. 3. Take at a different time of day than warfarin (Coumadin). 4. Do not skip any scheduled appointments to have blood drawn for labs.

Correct Answer: 1 Herbal remedies such as evening primrose oil, garlic, gingko biloba, or grapeseed extract can increase the effect of the aspirin. Itching is not a common side effect of aspirin therapy. Aspirin and warfarin (Coumadin) are not to be taken concurrently. No lab appointments will be made just for aspirin therapy.

During patient teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease? 1. elevated homocysteine 2. elevated creatinine 3. elevated high density lipoprotein (HDL) 4. elevated INR

Correct Answer: 1 Homocysteine levels are negatively correlated with serum folate and dietary folate intake; that is, increasing folate intake lowers homocysteine levels. Elevated creatinine indicates kidney disease. HDL is the good cholesterol and when elevated it will decrease the risk for the development of CAD. INR is a laboratory test that measures blood clotting function, not CAD.

During an office visit, a 55-year-old female patient asks why she has not been prescribed a daily dose of aspirin when her 56-year-old husband has been. What should the nurse explain is the most likely reason for this? 1. The benefit of aspirin in women under age 65 is not clear. 2. Aspirin is not recommended for women. 3. This must have been an oversight. 4. She has other medications that could interfere.

Correct Answer: 1 In women, the benefit of low-dose aspirin in reducing the risk for coronary heart disease is not clear prior to 65 years of age. Aspirin is recommended for women over the age of 65. This was not an oversight. There is not enough information to determine whether the patient has other medications that could interfere with aspirin.

What is the priority nursing intervention for a patient with a junctional escape rhythm? 1. Assess the patient for symptoms associated with this rhythm. 2. Contact the physician immediately for emergency orders. 3. Eliminate caffeine from the diet. 4. Prepare for a pacemaker insertion.

Correct Answer: 1 Junctional escape rhythms may be monitored if the patient is not symptomatic. It is most important to assess the patient to see how they are affected by the rhythm. Calling the physician to report the rhythm may be appropriate if the patient is symptomatic. Eliminating caffeine or preparing for a pacemaker insertion is not an appropriate action for this patient with a junctional escape rhythm. No indication of symptoms relating to the rhythm was given.

A patient asks about metabolic syndrome. How should the nurse respond to this patient? 1. "Metabolic syndrome is caused by obesity, physical inactivity, and genetic factors." 2. "This syndrome is not a concern for females unless they smoke." 3. "This problem affects only older adults over the age of 65." 4. "It can be avoided by taking vitamins daily and drinking 64 fluid ounces of water a day."

Correct Answer: 1 Metabolic syndrome is caused by obesity, physical inactivity, and genetic factors. The syndrome is not directly related to smoking and age. Daily vitamin and fluid consumption have not been found to alter the syndrome.

The nurse is caring for a patient with premature ventricular contractions (PVCs). What should the nurse keep in mind about this heart rhythm? 1. PVCs are insignificant in people with no history of heart disease. 2. PVCs typically have no pattern. 3. The frequency of PVCs is not associated with specific events. 4. Their incidence and significance has no relevance to the patient having had a myocardial infarction.

Correct Answer: 1 PVCs often have no significance in people without history of heart disease. PVCs may be isolated or occur in specific patterns. They may be triggered by anxiety or stress; tobacco, alcohol or caffeine use; hypoxia, acidosis, and electrolyte imbalances; sympathomimetic drugs; and coronary heart disease. They may be associated with an increased risk for lethal dysrhythmias and their incidence and significance is greatest after myocardial infarction.

The nurse is caring for a patient diagnosed with Prinzmetal or variant angina. What does the nurse realize this indicates for the patient? 1. It indicates presence of coronary artery spasm. 2. It indicates there is associated renal disease. 3. It indicates there is associated pulmonary disease. 4. It indicates the presence of a myocardial infarction.

Correct Answer: 1 Prinzmetal (variant) angina is atypical angina that occurs unpredictably (unrelated to activity) and often at night. It is caused by coronary artery spasm with or without an atherosclerotic lesion. The exact mechanism of coronary artery spasm is unknown. Prinzmetal angina does not occur due to renal disorders, pulmonary disorder, and is not specifically diagnostic for a myocardial infarction.

Upon auscultating the chest of a 75-year-old patient who recently experienced a myocardial infarction (MI), the nurse hears an S3 and lung crackles. Because of these findings, the nurse should assess for what other condition? 1. heart failure 2. extension of the MI 3. renal failure 4. liver failure

Correct Answer: 1 S3 and lung crackles are indications of heart failure. Manifestations of MI extension include chest pain and a return of positive laboratory finding (CK-MB and troponin). Renal failure is a late complication of heart failure and is not manifested with an S3 and crackles. Liver failure is not manifested with an S3 and crackles.

The nurse assessing a middle-aged patient experiencing chest pain realizes that presence of what symptom would be most characteristic of an acute myocardial infarction? 1. substernal pressure type pain, radiating down the left arm 2. colic-like epigastric pain 3. sharp, well-localized unilateral chest and left arm pain 4. sharp, burning chest pain moving from place to place

Correct Answer: 1 The cardinal manifestation of ACS is chest pain, usually substernal or epigastric. The pain often radiates to the shoulders, neck, jaw, or arm. Cardiac chest pain is not usually described as colic-like, localized to a defined spot such as the epigastric area, or as a sharp pain. The clinical manifestations of angina pectoris include a sudden onset of discomfort in the chest, jaw, shoulder, back, or arm, aggravated by exertion or emotional stress.

The nurse is caring for a patient experiencing acute myocardial infarction. What electrocardiogram change should the nurse expect for this patient's health problem? 1. ST-segment elevation 2. loss of P waves 3. bradycardia 4. widening of the QRS complex

Correct Answer: 1 The electrocardiogram reflects changes in conduction due to myocardial ischemia and necrosis. Classic ECG changes seen in acute myocardial infarction include ST-segment elevation. Loss of P waves occurs with atrial flutter and fibrillation. Bradycardia can be a normal or abnormal rhythm. Widening of the QRS complex occurs with bundle branch block.

What diagnostic test should the nurse anticipate as the priority for a patient admitted with chest pain to determine coronary artery status? 1. coronary angiography 2. stress electrocardiography 3. echocardiography 4. radionuclide testing

Correct Answer: 1 The gold standard for evaluating coronary arteries is coronary angiography. The other tests may be used, but are not the primary exam. A stress electrocardiogram will probably not be done until the angiography is completed and analyzed. An echocardiogram evaluates cardiac structure and function and not coronary arteries. Radionuclide testing evaluates myocardial perfusion and left ventricular function but does not specifically focus on the coronary arteries.

A patient reports chest pain, nausea, and vomiting off and on for the last 4 days, which the patient interpreted as the flu. What laboratory test(s) will provide information about acute cardiac damage for this patient? 1. troponin I and T 2. red blood cells 3. CK-MB 4. homocysteine and platelets

Correct Answer: 1 The levels of Troponin T begin to rise within 2‒4 hours after myocardial injury and remain elevated 10‒14 days. Levels of Troponin I begin to increase in about 2‒4 hours after myocardial ischemia and peak at 24‒36 hours and remain elevated for 7‒10 days. Red blood cells are unaffected by acute cardiac damage. The CK-MB rises within 4‒8 hours after the MI, peaks within 18‒24 hours and levels return to normal 2‒3 days following the infarction. This patient would most likely have normal values 4 days out from the onset of symptoms. Homocysteine does not change with acute cardiac damage. Platelets are unaffected by acute cardiac damage.

A nurse is performing cardiopulmonary resuscitation (CPR) on a patient who is in cardiac arrest. An automatic external defibrillator (AED) is available. What activity will allow the nurse to assess the patient's cardiac rhythm? 1. Apply adhesive patch electrodes to the chest and move away from the patient. 2. Apply standard electrocardiographic monitoring leads to the patient and observe the rhythm. 3. Hold the defibrillator paddles directly against the patient's chest. 4. Connect electrocardiographic electrodes to a telephone monitoring device and wait until the rhythm is analyzed.

Correct Answer: 1 The nurse applies adhesive patch electrodes to the patient's chest in the usual defibrillator positions, stops CPR, and orders everyone near the patient to move away and not touch the patient. The defibrillator analyzes the rhythm, which may take up to 30 seconds. The machine then indicates if defibrillation is indicated. Standard electrocardiographic monitoring leads, defibrillator paddles, and telephone monitoring devices are not used with an AED.

A patient is prescribed atorvastatin (Lipitor). For which adverse effect should the nurse monitor this patient? 1. liver enzyme alteration 2. blood glucose and uric acid level alteration 3. renal function alteration 4. sudden back pain and constipation

Correct Answer: 1 The nurse should be observing lab work for the current cholesterol level and to ensure that liver enzymes remain normal. Blood glucose, uric acid level, renal function, constipation, and sudden back pain are generally not associated with the use of this drug.

The nurse is assessing a patient who is six hours postoperative from coronary artery bypass graft (CABG) surgery. The patient's heart rate is 120, blood pressure is 90/50, urine output is decreased, chest tube output is decreased, heart sounds are muffled, and peripheral pulses are diminished. What action should the nurse take first? 1. Notify the physician immediately. 2. Recheck vital signs in 15 minutes. 3. Reposition the patient. 4. Increase the intravenous fluids.

Correct Answer: 1 The patient is exhibiting signs of cardiac tamponade. This is a medical emergency, and the physician must be notified immediately. Delaying the response by waiting 15 minutes or repositioning the patient will be ineffective. No change in intravenous fluids should be made until a physician order is given to do so. Cardiac tamponade is a life-threatening postoperative complication that can lead to cardiogenic shock and possibly cardiac arrest.

Sinus bradycardia (rate 56 beats per minute) is identified in a sleeping patient on telemetry. What is the priority nursing action? 1. Awaken the patient and see how the heart rate responds. 2. Call the physician and report this dysrhythmia. 3. Check the medication administration record and see if there is a PRN medication that will improve this rhythm. 4. Call for an immediate 12-lead electrocardiogram (ECG).

Correct Answer: 1 The priority is to awaken the patient to determine how the heart rate is affected with activity as it normally should increase. The patient should be evaluated to determine how the dysrhythmia is affecting heart function. Many patients who are asymptomatic while in sinus bradycardia can be observed and require no further intervention. Common reasons for sinus bradycardia for the nurse to consider include athletic conditioning, sleep, or a conduction disorder. Notifying the physician without first assessing the patient's response would not be appropriate. Checking the medication administration is not the priority nursing action. Ordering an ECG requires a physician's prescription.

The nurse is preparing medications for a patient with hyperlipidemia. What information should the nurse consider when administering these medications? 1. Such medications include the statins, which act by lowering LDL levels. 2. These medications act by increasing the LDL levels and decreasing the HDL levels. 3. These medications do not include angiotensin-converting enzyme (ACE) inhibitors. 4. Such medications include bile acid sequestrants as first-line drugs to lower cholesterol levels.

Correct Answer: 1 The statin drugs specifically lower LDL. Hyperlipidemia drugs are meant to lower LDL and raise HDL, not the opposite. The use of angiotensin-converting enzyme (ACE) inhibitors depends upon the patient's health status. Bile acid sequestrant drugs are not first-line drugs but may be added to statins when combination treatment is needed.

The nurse has completed teaching related to dietary management of coronary heart disease (CHD). Effective teaching is indicated by what patient statement? 1. "I can lower my trans fatty acids by switching to the soft margarines and vegetable spreads." 2. "I will watch my fiber intake so I don't get too much." 3. "Well, I'll just have to go buy some of that coconut oil to cook with." 4. "Drinking a couple of glasses of milk each day will give me better protein."

Correct Answer: 1 Trans fatty acids behave like saturated fats and are found in solid vegetable fats (margarine, shortening) and stick butter. Therefore, the use of soft margarines and vegetable spreads is recommended for managing CHD. Other dietary recommendations include increasing soluble and insoluble fiber in the diet. High proportions of saturated fats are found in coconut oil, whole-milk products, and red meats.

The nurse is caring for an adult patient who is admitted with chest pain that began four hours ago. Which test will be most specific in identifying acute heart damage? 1. troponin 2. CK 3. CK-MB 4. cholesterol

Correct Answer: 1 Troponin is primarily located in cardiac muscle and can indicate myocardial infarction or unstable angina. Troponin elevates at 2‒4 hours after myocardial infarction. CK and CK-MB will elevate with myocardial damage but will take longer to rise and are not as specific as troponin. Cholesterol level is not helpful in diagnosis of myocardial damage.

The nurse sees this rhythm on a patient's cardiac monitor. For which rhythm should the nurse begin care? 1. ventricular fibrillation 2. atrial flutter 3. sinus tachycardia 4. ventricular tachycardia

Correct Answer: 1 Ventricular fibrillation is too rapid to count and is grossly irregular; P:QRS shows no identifiable P waves; the PR interval is absent, and the QRS interval is bizarre and varies in shape and direction. It is important to identify this rhythm since it is a medical emergency and is known as cardiac arrest since the heart is not pumping. Death will follow if this situation is not resolved within four minutes. This rhythm is not atrial flutter, sinus tachycardia, or ventricular tachycardia.

The nurse is instructing a patient on nitroglycerin tablets prescribed to treat angina. Which statement(s) should be included in the nurse's instructions? Standard Text: Select all that apply. 1. "Take a second dose if the angina is not relieved within five minutes." 2. "The drug should remain in this brown bottle since it is sensitive to light." 3. "Store this medication in your bathroom medicine cabinet so it is readily available to you." 4. "Eating or drinking will not interfere when taking the medication." 5. "Call your doctor immediately if you develop a headache when taking this drug."

Correct Answer: 1, 2 A second dose of nitrates is recommended within five minutes if the first dose does not relieve the angina. Sublingual nitrates should not be removed from their original amber bottle since it protects the medication from light. They should be stored in a dry location and not placed in the bathroom medicine cabinet since moisture affects nitrates. This medication is taken sublingually; therefore, eating and drinking will interfere with absorption. A transient headache may occur when taking this medication and will diminish over time.

A patient recovering from cardiovascular surgery has a chest tube output of 110 mL/hr. What should the nurse do? Standard Text: Select all that apply. 1. Report to the surgeon. 2. Check the hemoglobin and hematocrit. 3. Administer a blood transfusion. 4. Notify the family. 5. Strip and vent the chest tube.

Correct Answer: 1, 2 Chest tube drainage greater than 70 mL/h indicates hemorrhage and may necessitate a return to surgery. The surgeon should be notified of this chest tube draining amount. A drop in hemoglobin and hematocrit may indicate hemorrhage that is not otherwise obvious. The patient needs to be assessed along with the laboratory data before it is determined if a blood transfusion is necessary. There is no need to notify family until the patient has been assessed. It may not be of significance. Stripping and venting of the chest tube is not necessary because of the use of a closed drainage system.

A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient should include which nursing actions? Standard Text: Select all that apply. 1. morphine intravenously and oxygen 2. aspirin 325 mg orally 3. open heart surgery 4. heparin drip at 100 units per hour 5. Foley catheter insertion

Correct Answer: 1, 2 Pain relief is vital in treating the patient with acute myocardial infarction (AMI). Pain stimulates the sympathetic nervous system, increasing the heart rate and blood pressure and, in turn, myocardial workload. Oxygen is administered by nasal cannula at 2 to 5 L/min to improve oxygenation of the myocardium and other tissues. Aspirin, a platelet inhibitor, is now considered an essential part of AMI treatment. A 160- to 325-mg aspirin tablet is given by emergency personnel, with the instructions that it is to be chewed (for buccal absorption). Open heart surgery may be indicated later. Heparin is not part of the admission protocol. A Foley catheter is not part of the admission protocol.

While discussing coronary heart disease risk factors with a group of factory employees, the nurse includes which options as modifiable risk factors? Standard Text: Select all that apply. 1. hypertension 2. diabetes mellitus 3. obesity 4. age 5. heredity

Correct Answer: 1, 2, 3 A person can make a choice to modify hypertension, diabetes mellitus, and obesity by controlling them through medications, weight control, diet, and exercise. Hereditary and aging effects on coronary heart disease cannot be changed.

A nurse is preparing a presentation on coronary heart disease (CHD) for a community women's club. Which statements should the nurse include in the presentation? Standard Text: Select all that apply. 1. The epigastric pain and nausea experienced with a heart attack are often attributed to heartburn. 2. Common symptoms of myocardial infarction (MI) include shortness of breath and fatigue. 3. Women are more likely to have an unrecognized myocardial infarction. 4. Weakness of the legs and back often precede a heart attack. 5. The mortality rate of young women having an MI is 50 % lower than that of men.

Correct Answer: 1, 2, 3 Common symptoms of MI in women include epigastric pain or nausea, which is blamed on heartburn, shortness of breath, fatigue, and weakness of the shoulders and upper arms. "Silent" or unrecognized heart attack occurs more frequently in women than men. Weakness of the legs and back does not precede a heart attack. The mortality rate of young women having an MI is twice that of men.

Coronary heart disease (CHD) is a major problem in the United States. What information on the medical history would alert the nurse to closely evaluate a patient for CHD? Standard Text: Select all that apply. 1. diabetes 2. hyperlipidemia 3. positive family history 4. a premenopausal woman 5. hypotension

Correct Answer: 1, 2, 3 Diabetes and hyperlipidemia are both disease conditions that contribute to coronary heart disease (CHD). Positive family history in some cases is considered a non-modifiable risk factor for CHD. Premenopausal women are not considered at an increased risk for CHD. Hypotension is not associated with development of CHD.

The nurse is caring for a patient with ventricular tachycardia. Which care should the nurse prepare to provide to this patient? Standard Text: Select all that apply. 1. immediate assessment and probable emergency intervention by the nurse 2. cardioversion, if sustained and symptomatic 3. administration of a potassium channel blocker 4. close observation for one hour prior to calling the physician 5. defibrillation to convert the rhythm in the awake patient

Correct Answer: 1, 2, 3 Sustained ventricular tachycardia is a medical emergency that requires immediate intervention, particularly in patients with cardiac disease. Treatment for ventricular tachycardia includes cardioversion. Class III antidysrhythmic medications (potassium channel blockers) are typically administered. Observation prior to calling a physician is not an appropriate action when a potentially life-threatening rhythm is identified. Defibrillation is only conducted in ventricular tachycardia when the patient is pulseless; otherwise, time is taken to synchronize for cardioversion.

A patient with coronary heart disease is prescribed niacin (Nicobid). What should the nurse instruct the patient about this medication? Standard Text: Select all that apply. 1. Take with meals and a cold beverage. 2. Take with prescribed statin medication. 3. Keep routine appointments for blood work. 4. Report facial flushing to the healthcare provider. 5. Drink 4 ounces of alcohol if facial flushing occurs.

Correct Answer: 1, 2, 3 The medication should be taken with meals and accompanied by a cold beverage to minimize GI effects. Because the doses required to achieve significant cholesterol-lowering effects are associated with multiple side effects, nicotinic acid generally is used in combination therapy, particularly with the statin drugs. Because this medication can have adverse effects routine monitoring of blood glucose, uric acid levels, and liver function tests should be done during treatment. Flushing of face, neck, and ears may occur within 2 hours following dose; these effects generally subside as treatment continues. Alcohol use during nicotinic acid therapy may worsen facial flushing.

The nurse is notified by the cardiac monitoring technician that a patient on continuous cardiac monitoring is having frequent alarms. When the nurse enters the patient's room, the patient is in no apparent distress, is sitting in the chair and eating. Which are appropriate nursing interventions? Standard Text: Select all that apply. 1. Confirm that lead wires are properly connected. 2. Assess placement of electrodes. 3. Remove and reapply new electrodes if nonadherent. 4. Assess skin sites and move an electrode if the skin appears irritated. 5. Call for assistance.

Correct Answer: 1, 2, 3, 4 Alarms may be triggered by loose or disconnected lead wires, poor electrode contact, excessive movement, electrical interference, or equipment malfunction. Nursing actions include assessing lead wire connections; assessing placement of electrodes and changing electrodes every 24 to 48 hours or removing and reapplying electrodes that are dislodged or non-adherent; assessing and documenting skin condition under the pads and moving pads to alternate sites to avoid skin irritation; and documenting ECG strips according to unit policy. Since the patient is in no apparent distress, assistance is not required.

A patient is experiencing supraventricular tachycardia. Which medications should the nurse prepare to administer to this patient? Standard Text: Select all that apply. 1. verapamil (Calan) 2. diltiazem (Cardizem) 3. amlodipine (Norvasc) 4. propafenone (Rythmol) 5. adenosine (Adenocard)

Correct Answer: 1, 2, 3, 5 Calcium channel blockers decrease automaticity and AV nodal conduction. They are used to manage supraventricular tachycardia. These medications include amlodipine (Norvasc), verapamil (Calan), and diltiazem (Cardizem). Adenosine (Adenocard) decreases conduction through the AV node and is used to treat supraventricular tachycardia. Propafenone (Rythmol) is used to reduce or eliminate tachydysthymias associated with reentry.

A patient identified as being at risk for coronary heart disease does not understand why exercise is important. What should the nurse explain to this patient? Standard Text: Select all that apply. 1. Exercise decreases blood pressure. 2. Exercise increases oxygen to the heart. 3. Exercise potentiates platelet aggregation. 4. Exercise decreases the workload of the heart. 5. Exercise improves the electrical ability of the heart.

Correct Answer: 1, 2, 4, 5 Cardiovascular benefits of exercise include increased availability of oxygen to the heart muscle, decreased oxygen demand and cardiac workload, and increased myocardial function and electrical stability. Other positive effects of regular physical activity include decreasing blood pressure and platelet aggregation.

A patient in the coronary care unit has the following cardiac rhythm: What action should the nurse take when caring for this patient? 1. Prepare to defibrillate. 2. Monitor for any changes. 3. Notify the healthcare provider. 4. Administer a dose of sublingual nitroglycerin.

Correct Answer: 2 This is a first-degree AV block. There is no action necessary for this dysrhythmia. This is not a life-threatening dysrhythmia. Defibrillation is not necessary. The healthcare provider does not need to be notified. Sublingual nitroglycerin is used for chest pain.

A patient with a high risk for coronary heart disease is prescribed a 1750-kcal diet in which 55% of the diet is to be carbohydrates and 20% fat. How many calories should the nurse instruct the patient consume as protein each day? Standard Text: Record your answer rounding up to the nearest whole number.

Correct Answer: 438 kcal Global Rationale: If the patient is to consume 55% of the diet as carbohydrates and 20% as fat that means the patient is to consume 25% of the total calories as protein. To determine protein calories, the nurse should multiply the total number of calories per day by 25%, or 1750 × .25 = 437.5 or 438 kcal.