SPC Level 2 Exam 3- Acute Coronary Syndrome Adaptive Quiz

The nurse is caring for a patient who is scheduled for an angioplasty with placement of a drug-eluting stent. In which order do the steps of the stent procedure occur? -Balloon is inflated. -Blockage is identified. -Improved blood flow occurs. -Intimal lining grows over the stent. -Stent is placed into the coronary artery.

1. Blockage is identified. 2. Stent is placed into the coronary artery. 3. Balloon is inflated. 4. Improved blood flow occurs. 5. Intimal lining grows over the stent. After blockage is identified, treatment options, including angioplasty with stent placement, are explored. Stents are small, expandable tubes that are inserted during angioplasty into a blocked section of the coronary artery to open the artery and improve blood flow. During angioplasty, the balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall to keep the narrowed artery open. Because the stent is like woven mesh, the cells lining the blood vessel grow through and around the stent to help secure it. Drug-eluting stents are coated with drugs that prevent scar tissue from growing into the artery. Drug-eluting stents may lower the chance that the patient will need a second procedure (angioplasty or surgery) to open the artery again.

A patient with angina states, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever. It was similar to the pain I had at home. The pain went away rather quickly." Which further subjective assessment data would the nurse obtain? -"What precipitated the pain?" -"Has the pain changed this time?" -"In what location did you feel the pain?" -"Please rate the pain on a scale from 0 to 10."

-"In what location did you feel the pain?" Using PQRST, the assessment data not volunteered by the patient is the radiation (R) of pain, the area in which the patient felt the pain and if it radiated. The precipitating event (P) was going to the bathroom and having a bowel movement. The quality (Q) of the pain was "like before I was admitted," although a more specific description may be helpful. Severity (S) of the pain was the "worst chest pain ever," although an actual number may be needed. Timing (T) is supplied by the patient describing when the pain occurred and that the patient had had this pain previously.

A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse include about physical activity? -"Start out with 30-minute sessions." -"Be sure to perform physical activity at least twice a week." -"Physical activity should be regular, rhythmic, and repetitive." -"Your heart rate during exercise should only be 30 beats over your resting rate."

-"Physical activity should be regular, rhythmic, and repetitive." Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30 minutes long. Instruct the patient to begin slowly at personal tolerance (perhaps only 5 to 10 minutes) and build up to 30 minutes. Encourage the patient to perform physical activity on most days of the week. Activity intensity is determined by the patient's heart rate. If an exercise stress test has not been performed, the heart rate of the patient recovering from an MI should not exceed 20 beats/min over the resting heart rate.

The nurse provides information about thrombolytic therapy to a group of student nurses. Which statement made by a student nurse indicates the need for further teaching? -"Significant head trauma within the past three months is a relative contraindication." -"A symptom of major bleeding with thrombolytic therapy is an increase in heart rate (HR)." -"The goal is to give the thrombolytic within 30 minutes of the patient's arrival to the emergency department." -"The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the electrocardiogram (ECG)."

-"Significant head trauma within the past three months is a relative contraindication." Significant closed-head or facial trauma within the past three months is an absolute contraindication due to increased risk of bleeding; the benefit does not outweigh the risk. Signs and symptoms of bleeding during thrombolytic therapy include a drop in BP, increase in HR, sudden change in the patient's mental status, and blood in the urine or stool. Treatment of ST-segment-elevation myocardial infarction (STEMI) with thrombolytic therapy aims to limit the infarction size by dissolving the thrombus in the coronary artery and reperfusing the heart muscle rapidly. The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG.

A patient phones a health care provider's office and states, "I am having severe chest tightness that won't go away even when I lie down." In addition to contacting emergency responders, which instruction would the nurse provide to the patient? -"Lie down with your feet elevated." -"Go to a neighbor's house to get assistance." -"Take chewable aspirin. The total dose should be 325 mg." -"Take your blood pressure. It will be useful to know for your care."

-"Take chewable aspirin. The total dose should be 325 mg." The symptoms described by the patient may be due to acute coronary syndrome (ACS). Advise the patient to take chewable aspirin; the dose is 162 to 325 mg (typically 4 baby aspirin or 2 adult aspirin). The patient's BP may be elevated, and lying with the feet elevated will most likely increase the BP. The patient should not increase oxygen demand by walking to a neighbor's house or by taking the BP.

A patient with acute coronary syndrome (ACS) receives a prescription for niacin to treat hyperlipidemia. The nurse observes another care provider giving information about the medication to the patient. Which item included in the education would the nurse question? -"Most side effects subside with time." -"Take the drug on an empty stomach." -"A side effect is flushing in the upper torso and face." -"Decreased liver function may occur with high doses."

-"Take the drug on an empty stomach." The drug should be taken with food. Side effects include flushing and pruritus in the upper torso and face, as well as gastrointestinal (GI) disturbances. Most side effects subside with time. Decreased liver function may occur with high doses.

The nurse teaches a student nurse about acute pericarditis. Which statement made by the student nurse indicates effective learning? -"I should massage the patient's chest region to relieve symptoms." -"The patient's pain can be relieved by sitting in the forward position." -"Acute pericarditis should be treated immediately by IV heparin." -"Treatment of acute pericarditis involves mitral valve repair or replacement."

-"The patient's pain can be relieved by sitting in the forward position." Acute pericarditis is an inflammation of the pericardium that may occur within two to three days of acute myocardial infarction. The patient's chest pain is relieved after sitting in the forward position. The pain may return after a change in position or inspiration. Massaging the chest region may aggravate the symptoms. IV heparin is given to a patient with an unstable thrombus or coronary artery spasm. Papillary muscle dysfunction treatment involves mitral valve repair or replacement. Acute pericarditis treatment involves nonsteroidal antiinflammatory agents, aspirin, and corticosteroids.

The nurse is caring for a patient who survived sudden cardiac death (SCD) caused by a lethal ventricular dysrhythmia. Which tests will likely be prescribed to monitor the effectiveness of drug treatment? Select all that apply. -24-hour Holter monitoring -Implantable cardiac monitor -MRI -Signal-averaged electrocardiogram (ECG) -Electrophysiologic study (EPS) under fluoroscopy

-24-hour Holter monitoring -Implantable cardiac monitor -Signal-averaged electrocardiogram (ECG) -Electrophysiologic study (EPS) under fluoroscopy Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence rate, they are closely monitored to assess when they are most likely to have a recurrence and to determine which drug therapies are most effective for them. This monitoring may include 24-hour Holter monitoring, implantable cardiac monitor, signal-averaged ECG, and an EPS done under fluoroscopy. MRI is not used to monitor for lethal dysrhythmias.

A patient who is being discharged from the hospital after acute coronary syndrome will be participating in cardiac rehabilitation. Which information will the nurse provide about the early recovery phase of rehabilitation? -Activity level depends on severity of angina or myocardial infarction (MI). -Therapeutic lifestyle changes should become lifelong habits. -Activity level is increased gradually with supervision and with electrocardiogram (ECG) monitoring. -The focus will be on management of chest pain, anxiety, dysrhythmias, and other complications.

-Activity level is increased gradually with supervision and with electrocardiogram (ECG) monitoring. In the early recovery phase after the patient is dismissed from the hospital, the activity level is increased gradually under supervision and with ECG monitoring. In the first phase of recovery, activity is dependent on the severity of the angina or MI. The late recovery phase includes therapeutic lifestyle changes that become lifelong habits. In the first phase of recovery attention is focused on the management of chest pain, anxiety, dysrhythmias, and other complications.

For which problem is percutaneous coronary intervention (PCI) initially indicated? -Chronic stable angina -Left-sided heart failure -Acute myocardial infarction -Coronary artery disease (CAD)

-Acute myocardial infarction PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.

Which type of medication may be prescribed for a patient with an ejection fraction (EF) of 25%? -Lipid-lowering agent -β-adrenergic blocker -Calcium channel blocker -Angiotensin-converting enzyme (ACE) inhibitor

-Angiotensin-converting enzyme (ACE) inhibitor Patients with chronic stable angina who have an EF of 40% or less should take an ACE inhibitor indefinitely, unless contraindicated. These drugs result in vasodilation and reduced blood volume. They also prevent ventricular remodeling and prevent the progression of heart failure in the patient. Lipid-lowering agents reduce low density cholesterol and triglyceride levels in the blood. β-adrenergic blockers decrease myocardial oxygen demand by reducing heart rate, BP, and contractility. Calcium channel blockers are prescribed to decrease BP in patients with β-blocker intolerance and Prinzmetal's angina.

Which drug class includes clopidogrel? -Opioid analgesic -Antiplatelet agent -Vitamin K antagonist -Nonsteroidal antiinflammatory drug (NSAID)

-Antiplatelet agent Clopidogrel (Plavix) is an antiplatelet agent used commonly in patients with cardiovascular disease. Plavix is not an opioid analgesic, vitamin K antagonist, or NSAID.

The nurse assesses a patient who has been diagnosed with papillary muscle dysfunction. Which observation supports the patient's diagnosis? -S3 heart sound -Murmur at the cardiac apex -Crackles in bilateral lung bases -Deep sound at the lower left sternal border

-Murmur at the cardiac apex Papillary muscle dysfunction occurs if the papillary muscles attached to the mitral valves are involved in infarction. A patient may have papillary muscle infarction if a murmur is heard upon auscultation at the cardiac apex. The presence of S3 and S4 sounds of the heart and crackles in breath sounds indicate heart failure. The deep sound heard at the lower left sternal border upon auscultation indicates acute pericarditis.

Which clinical manifestations in a patient with chest pain are associated with myocardial infarction (MI)? Select all that apply. -Flushing -Ashen skin -Diaphoresis -S3 or S4 heart sounds -Nausea and vomiting

-Ashen skin -Diaphoresis -S3 or S4 heart sounds -Nausea and vomiting During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy as a result of this response. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Skin is ashen and clammy rather than flushed.

A patient reports heaviness and burning sensation in the substernal and retrosternal region. Which assessment finding would indicate sympathetic nervous system stimulation? -Jugular venous distention -Abnormal S3 and S4 sounds -Ashen, clammy, and cool skin -Shortness of breath and anxiety

-Ashen, clammy, and cool skin A patient with heaviness and burning sensation in the substernal and retrosternal region may be having a myocardial infarction (MI) and stimulation of the sympathetic nervous system. This condition may trigger the production of catecholamines, which promote glycogen release, diaphoresis, and vasoconstriction of peripheral blood vessels. Because of this, the patient's skin may appear ashen, clammy, and cool to the touch. Jugular vein distention and abnormal S3 and S4 sounds are caused by ventricular dysfunction. Shortness of breath and anxiety may not necessarily be caused by sympathetic nervous system stimulation.

The nurse is providing postoperative care to a patient who underwent coronary artery bypass graft (CABG) surgery. For which common complication would the nurse monitor the patient? -Dehydration -Paralytic ileus -Atrial dysrhythmias -Acute respiratory distress syndrome

-Atrial dysrhythmias Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first three days following CABG surgery. Although dehydration, paralytic ileus, and acute respiratory distress syndrome could occur, they are not common complications.

A patient receives morphine sulfate to relieve chest pain. For which adverse effects would the nurse monitor the patient? Select all that apply. -Bradypnea -Dysrhythmias -Bradycardia -Hypotension -Decreased ejection fraction

-Bradypnea -Hypotension Morphine sulfate is prescribed to patients with chest pain. Morphine acts as a vasodilator; it decreases cardiac workload, contractility, and BP. The nurse should monitor for signs of bradypnea and hypotension to avoid myocardial ischemia and infarction. The nurse should monitor dysrhythmias and bradycardia in a patient receiving docusate. Morphine sulfate does not directly affect ejection fraction; indirectly, improved oxygenation will lead to more effective cardiac pumping.

The nurse provides a list of health-promoting regular physical activity examples to a patient with coronary artery disease (CAD). Which activity would the nurse include on the list? -Painting while seated -Performing carpentry -Jogging (7 to 8 miles per hour) -Brisk walking (3 to 4 miles per hour)

-Brisk walking (3 to 4 miles per hour) Physical activity improves the physiologic functioning and psychologic well-being of a patient with acute coronary syndrome. Therefore the nurse should encourage the patient to walk at a rate of 3 to 4 miles per hour. Painting while seated is a low-energy activity. Carpentry and running at 7 miles per hour are high-energy activities for a patient with acute coronary syndrome.

The nurse is caring for a patient 24 hours after the patient was diagnosed with ST-segment-elevation myocardial infarction (STEMI). For which complication of myocardial infarction (MI) would the nurse monitor this patient? -Unstable angina -Cardiac tamponade -Sudden cardiac death -Cardiac dysrhythmias

-Cardiac dysrhythmias The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.

The nurse is providing teaching to a patient recovering from a myocardial infarction (MI). In which way would the nurse plan for resumption of sexual activity to be discussed? -Delegated to the health care provider -Discussed along with other physical activities -Avoided because it would be embarrassing to the patient -Accomplished by providing the patient with written material

-Discussed along with other physical activities Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex as a physical activity and to discuss or explore feelings in this area when other physical activities are discussed. The discussion of sexual activity should not be delegated to the health care provider or avoided because of embarrassment. Although providing the patient with written material is appropriate, it should not replace a verbal dialogue that can address the individual patient's questions and concerns.

The nurse is caring for a patient one month after the patient had a myocardial infarction. The patient is hospitalized with a three-day history of chest pain, joint pain, and a body temperature of 101° F (38.3° C). The patient's lab results include a white blood cell count of 15,000/mcL and an erythrocyte sedimentation rate of 30 mm/hr. Which condition would the nurse suspect? -Pneumonia -Hiatal hernia -Dressler syndrome -Ventricular aneurysm

-Dressler syndrome Dressler syndrome is pericarditis that develops four to six weeks after myocardial infarction. This syndrome is caused by an antigen-antibody reaction to the necrotic myocardium, and the patient may experience pericardial pain, fever, and arthralgia. Laboratory findings of an elevated white blood cell count and sedimentation rate also indicate Dressler syndrome. Note that the normal level of white blood cells is 10,000/cc and the normal range of sedimentation rate is 0 to 22 mm/hr for men and 0 to 29 mm/hr for women. Pneumonia and hiatal hernia can cause chest pain that requires emergency management. Ventricular aneurysm results from thinning of myocardial wall during contraction.

A patient with Prinzmetal's angina who takes a short-acting nitrate reports feeling dizzy while changing positions. Which prescription would the nurse anticipate? -Esmolol -Morphine sulfate -IV heparin -IV fluid bolus

-IV fluid bolus Prinzmetal's angina is treated with short-acting nitrates, such as nitroglycerin. Orthostatic hypotension is a common side effect of nitroglycerin because of the depletion of body fluid volume. Therefore the patient may be administered IV fluid bolus. β-blockers such as esmolol can lead to hypotension, which may further worsen the patient's condition. IV heparin is administered to a patient undergoing thrombolytic therapy; heparin is not suggested for a patient with Prinzmetal's angina. Morphine sulfate is the drug of choice for chest pain during angina that is unrelieved by nitroglycerin.

A patient who survived an episode of sudden cardiac death (SCD) is recovering in the intensive care unit (ICU). Which intervention would the nurse anticipate to prevent a recurrence? -Drug therapy with β-blocker -Coronary artery bypass graft (CABG) -Percutaneous coronary intervention (PCI) -Implantable cardioverter-defibrillator (ICD)

-Implantable cardioverter-defibrillator (ICD) The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A CABG is not necessary.

In which location would a myocardial infarction (MI) occur due to blockage of the right coronary artery? -Inferior wall -Anteroseptal -Anterolateral -Anterior wall

-Inferior wall Blockage of the right coronary artery may result in an inferior wall MI because the right coronary artery supplies blood to the inferior wall of the heart. Damage to one or more other coronary arteries may result in anteroseptal and anterolateral MIs. Anterior wall infarctions result from blockages in the left anterior descending artery.

The nurse is reviewing a plan of care for emergency treatment of a patient with chest pain. Which item listed on the plan would the nurse question? -Give a high-dose statin medication. -Give 162 to 325 mg aspirin (chewable). -Start O2 by nasal cannula to keep O2 saturation above 93%. -Instruct the patient to do coughing and deep-breathing exercises.

-Instruct the patient to do coughing and deep-breathing exercises. Rapid diagnosis and providing treatment to a patient with acute coronary syndrome help to preserve cardiac muscle function. The initial treatment is to manage chest pain; therefore the patient needs to rest and limit activities (including breathing exercises) for 12 to 24 hours. The nurse should make sure that the oxygen saturation stays at an acceptable level by initiating supplemental oxygen. Aspirin is part of the antiplatelet therapy. Statins are lipid-lowering drugs. They block synthesis of cholesterol and increase low-density lipoprotein receptors in the liver.

Which artery is most commonly used for coronary bypass grafts? -Radial -Gastroepiploic -Inferior epigastric -Internal mammary

-Internal mammary Bypass graft surgery involves the replacement of blood vessels that transport blood between the aorta and the blocked coronary artery. The internal mammary artery (IMA) is the most common artery used for bypass graft. The long-term patency rate for an IMA graft is greater than 90% after 10 years. Procedures involving the radial, gastroepiploic, or inferior epigastric artery have a comparatively short-term patency rate.

The nurse is caring for a patient having a myocardial infarction. The health care provider prescribes an IV infusion of alteplase. Which intervention would the nurse include during the administration of this medication? -Monitor for changes in neurologic status. -Assess BP for orthostatic changes. -Apply a pressure dressing to IV insertion sites. -Start additional IV lines after alteplase infusion has begun.

-Monitor for changes in neurologic status. Assessment for changes in neurologic status is the priority nursing intervention because this may indicate a cerebral bleed during the thrombolytic infusion. Monitoring BP for orthostatic changes is necessary with the use of short-acting nitrates. Application of a pressure dressing to the IV insertion site is not done unless evidence of bleeding is noted. Additional IV therapy lines should be inserted before the alteplase begins. Perform all other invasive procedures before giving the thrombolytic agent to reduce the risk for bleeding.

The nurse provides a student nurse with information related to management of a patient following cardiac catheterization. Which intervention would the nurse explain is the specific responsibility of the nurse, rather than that of assistive personnel (AP)? -Recording vital signs -Monitoring neurovascular changes -Asking the patient about comfort measures -Assisting with oral hygiene, hydration, and meals

-Monitoring neurovascular changes The nurse is responsible for monitoring changes in neurovascular status or bleeding. AP take vital signs. All members of the health care team can address measures that will make the patient more comfortable. AP assist with oral hygiene, hydration, meals, and toileting.

The nurse is preparing an initial care plan for a patient who presents with chest pain. Which is the priority nursing intervention? -Monitoring the patient's cardiac rhythm -Discussing the losses associated with chronic illness -Encouraging verbalization of feelings, perceptions, and fears -Advising the patient to avoid heavy meals and extreme weather conditions

-Monitoring the patient's cardiac rhythm A patient with chest pain may have acute coronary syndrome. The priority is to stabilize the patient, determine the plan of care, and prevent complications. Ongoing care should include continuous electrocardiogram (ECG) monitoring. The nurse should help the patient with anxiety and stress to work on the losses due to chronic illness to prevent sudden depression-related cardiac workload, but that is not the highest priority. A patient with chronic stable angina is advised to avoid heavy meals and extreme weather to reduce the probability of symptoms, and this may be appropriate to teach at a later time. The nurse should encourage verbalization of feelings, perceptions, and fears that increases workload on heart but that is not a higher priority than monitoring for life-threatening dysrhythmias.

A patient who has received a maximum dose of nitroglycerin continues to report chest pain. Which medication would the nurse anticipate administering to this patient next? -Esmolol -Docusate -Ticagrelor -Morphine sulfate

-Morphine sulfate Morphine sulfate is the drug of choice for a patient with unrelieved chest pain, even after the administration of nitroglycerin. Esmolol is a β-blocker used to slow down the heart during minimally invasive direct coronary artery bypass (MIDCAB). Docusate is a stool softener that facilitates bowel movements. Ticagrelor is used in dual antiplatelet therapy on a patient with ongoing angina and negative cardiac markers.

The nurse assesses a patient with diabetes who reports shortness of breath, neck pain, and hypoglycemic symptoms. The patient's BP is 130/86 mm Hg, heart rate is 102 beats/min, respiratory rate is 24 breaths/min, and the finger-stick blood glucose is 136 mg/dL. Which condition would the nurse suspect? -Myocardial infarction (MI) -Late-stage diabetic ketoacidosis -Early-onset diabetic ketoacidosis -Hyperosmolar hyperglycemic nonketotic syndrome

-Myocardial infarction (MI) Signs and symptoms of an MI include shortness of breath, neck pain, and cool, clammy skin. Although cool, clammy skin may resemble a hypoglycemic reaction, when found along with shortness of breath and neck pain it is very specific for an MI. The patient is not experiencing a complication of diabetes (ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome). The blood glucose is close to normal, and further diagnostics would be required to determine a diabetic complication.

Cardiac biomarker levels are being evaluated for a patient who is suspected of having a myocardial infarction (MI). Which biomarker lacks specificity for diagnosing an MI? -Myoglobin -Creatine kinase-MB (CK-MB) -Cardiac-specific troponin I (cTnI) -Cardiac-specific troponin T (cTnT)

-Myoglobin Myoglobin is a serum cardiac marker that is released into the circulation within two hours after an MI. Myoglobin's role in diagnosing MI is limited because it lacks cardiac specificity. Creatine kinase-MB (CK-MB) levels begin to rise about six hours after an MI, are specific to myocardial cells, and help quantify myocardial damage. Cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI) are highly specific indicators of MI.

Which therapy would the nurse anticipate administering for emergency care of a patient with a suspected myocardial infarction (MI)? -Oxygen, nitroglycerin, aspirin, and morphine -Aspirin, nitroprusside, dopamine, and oxygen -Nitroglycerin, lorazepam, oxygen, and warfarin -Oxygen, furosemide, nitroglycerin, and meperidine

-Oxygen, nitroglycerin, aspirin, and morphine The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. Furosemide, meperidine, nitroprusside, dopamine, lorazepam, and warfarin may be used later in the patient's treatment.

The nurse is examining the electrocardiogram (ECG) of a patient who has just been admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion? -Sinus tachycardia -Pathologic Q wave -Fibrillatory P waves -Prolonged PR interval

-Pathologic Q wave The presence of a pathologic Q wave, which often accompanies ST-segment-elevation myocardial infarction (STEMI), is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.

Diagnostic tests confirm that a patient is experiencing a ST-segment-elevation myocardial infarction (STEMI). For which first line of treatment will the nurse prepare the patient? -Antiplatelet and statins therapy -Dual antiplatelet therapy and heparin -Transmyocardial laser revascularization -Percutaneous coronary intervention (PCI)

-Percutaneous coronary intervention (PCI) Emergent PCI is the first line of treatment for patients with confirmed STEMI (i.e., ST-elevation on the electrocardiogram [ECG] and/or positive cardiac biomarkers). The goal is to open the blocked artery within 90 minutes of arrival to a facility that has an interventional cardiac catheterization laboratory. Antiplatelet and statins therapy improves vein graft patency in a patient who has undergone coronary artery bypass grafting (CABG) involving the saphenous vein. Dual antiplatelet therapy and heparin will help a patient with ongoing angina and negative cardiac markers. Transmyocardial laser revascularization is used for a patient with advanced coronary artery disease and persistent angina even after maximum medical therapy.

A patient who has recently had a myocardial infarction experiences mild chest pain during inspiration, while coughing, and while performing daily activities. Sitting in a forward position relieves the pain. Which complication would the nurse suspect the patient is experiencing? -Pericarditis -Ventricular aneurysm -Left-sided heart failure -Papillary muscle dysfunction

-Pericarditis Chest pains experienced during inspiration, coughing, and performing activities that goes away upon sitting forward indicate acute pericarditis in the patient. A ventricular aneurysm may result from thinning of the infarcted myocardial walls. Left-sided heart failure occurs initially with subtle signs such as mild dyspnea, restlessness, agitation, or slight tachycardia. Papillary muscle dysfunction occurs when the infarcted area includes the papillary muscle that attaches to the mitral valve.

The nurse provides basic exercise guidelines for a patient who is being discharged following acute coronary syndrome (ACS). Which guidelines following the FITT formula would the nurse recommend? -Physical activity that is regular, rhythmic, and repetitive -An increase in heart rate of 25 beats/min over the resting heart rate (HR) -Physical activity sessions that begin at 5 to 10 minutes and build up to 45 minutes -Mild weightlifting for 10 minutes to allow stretching of muscles before exercising

-Physical activity that is regular, rhythmic, and repetitive The FITT formula includes physical activities that are regular, rhythmic, and repetitive, using large muscles to build up endurance. The increase in HR should not exceed 20 beats/min over the resting HR. The physical activity session should build up to 30 minutes. There is no weightlifting included in the formula.

A patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB). Which steps are involved in the procedure? Select all that apply. -A robot is used to replace the mitral valve. -Small incisions are made between the ribs. -Cardiac catheterization is performed during the procedure. -A mechanical stabilizer is placed to immobilize the operative site. -A thoracoscope or robotic assistance is used to free the internal mammary artery.

-Small incisions are made between the ribs. -A mechanical stabilizer is placed to immobilize the operative site. -A thoracoscope or robotic assistance is used to free the internal mammary artery. MIDCAB offers patients with disease of the left anterior descending or right coronary artery an approach to surgical treatment that does not involve a sternotomy and cardiopulmonary bypass (CPB). It involves several small incisions between the ribs to dissect the internal mammary artery (IMA) with a thoracoscope or with robotic assistance. The heart is then slowed or stopped temporarily with adenosine, which is assisted by a mechanical stabilizer to immobilize the operative site. The IMA is then sutured to the coronary artery. A robot is used to replace the mitral valve during robot-assisted cardiothoracic surgery. Transmyocardial laser revascularization involves cardiac catheterization. Mechanical stabilizers are used on a beating heart during off-pump coronary artery bypass.

A patient is admitted to the intensive care unit in stable condition with a diagnosis of myocardial infarction. Which common medications will be used to treat this condition? Select all that apply. -Diuretics -Stool softeners -Prophylactic antibiotics -Dual antiplatelet therapy -IV nitroglycerin -Low -molecular-weight heparin (LMWH)

-Stool softeners -Dual antiplatelet therapy -IV nitroglycerin -Low -molecular-weight heparin (LMWH) After an MI, the patient may be predisposed to constipation because of bed rest and opioid drugs. Stool softeners (e.g., docusate sodium [Colace]) prevent straining and the resultant vagal stimulation from the Valsalva maneuver. Vagal stimulation produces bradycardia and can provoke dysrhythmias. Drug therapy for myocardial infarction includes IV nitroglycerin, dual antiplatelet therapy (e.g., aspirin and clopidogrel), and systemic anticoagulation with either LMWH given subcutaneously or IV unfractionated heparin, which are the initial drug treatments of choice for acute coronary syndrome (ACS). Diuretics and prophylactic antibiotics are not appropriate at this time.

A patient asks the nurse about resuming sexual activity after acute coronary syndrome (ACS). Which information would the nurse include in the patient's teaching plan? -Take a hot shower just before intercourse to provide relaxation. -Limit the time, including foreplay, to 30 minutes to prevent overexertion. -Wait an hour after ingesting a large meal before engaging in sexual activity. -Taking a prophylactic nitrate may decrease chest pain during sexual activity.

-Taking a prophylactic nitrate may decrease chest pain during sexual activity. Taking a prophylactic nitrate may decrease chest pain during sexual activity. Hot or cold showers should be avoided just before or after intercourse. Consumption of food and alcohol should be reduced before intercourse is anticipated (e.g., waiting three to four hours after ingesting a large meal before engaging in sexual activity). There is no established time limit. Foreplay is desirable because it allows a gradual increase in heart rate before orgasm.

A patient tells the nurse, "I had severe chest pain six days ago." Which cardiac biomarker will be most helpful in determining whether the patient had a myocardial infarction at the time the patient experienced chest pain? -Troponin -Myoglobin -Homocysteine -Creatine kinase (CK)

-Troponin Troponin is a serum cardiac marker that is detectable in the blood up to two weeks after myocardial injury and is used to diagnose a myocardial infarction. Troponin has two subtypes: cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI). Serum levels of cTnT and cTnI increase 4 to 6 hours after the onset of myocardial injury, peak at 10 to 24 hours, and return to baseline over 10 to 14 days. Myoglobin is a protein found in skeletal and cardiac muscle. It is a sensitive indicator of early myocardial injury but is not specific for cardiac muscle; therefore it is not used to diagnose a myocardial infarction. Myoglobin peaks and returns to normal in 3 to 15 hours. Homocysteine is a protein. High levels of homocysteine may indicate an increased risk for coronary artery disease. It is not used to diagnose myocardial infarction. CK levels begin to rise about 6 hours after an MI, peak at about 18 hours, and return to normal within 24 to 36 hours.