7100: EAQ 5
The nurse provides education to a patient that receives a prescription for sublingual nitroglycerin for treatment of angina. Which statement made by the patient indicates the need for further teaching? 1 "I cannot take sildenafil and nitroglycerin at the same time." 2 "I can take a tablet 5 to 10 minutes before starting an activity that causes angina." 3 "After taking a tablet, I may experience a headache, dizziness, or flushing." 4 "After the bottle is open, the tablets lose potency and should be replaced every 12 months."
"After the bottle is open, the tablets lose potency and should be replaced every 12 months." After the bottle is open, the tablets lose potency and should be replaced every 6 months. The patient can take the medication prophylactically before starting an activity that is known to cause angina. In these cases the patient can take a tablet or spray 5 to 10 minutes before beginning the activity. Headache, dizziness, or flushing may occur after taking the medication. Patients should be instructed not to combine nitroglycerin with drugs used for erectile dysfunction (e.g., sildenafil [Viagra]) as severe hypotension can occur.
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, what instruction should the nurse provide to the patient? 1 "Lie down with your feet elevated." 2 "Go to a neighbor's house to get assistance." 3 "Take chewable aspirin. The total dose should be 325 mg." 4 "Take your blood pressure. It will be useful information 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 should not increase oxygen demand by walking to a neighbor's house or by taking the BP. The patient's BP may be elevated and lying with the feet elevated will most likely increase the BP.
A nurse provides care to a patient with atrial flutter that is clinically stable. The nurse anticipates a prescription for which types of medication? Select all that apply. 1 Calcium channel blocker 2 Antidysrhythmia medication 3 β- blocker 4 Anticoagulant 5 Anticholinergic medication
-Calcium channel blocker -Antidysrhythmia medication -β- blocker Calcium channel blockers delay AV node conduction and reduce myocardial contractility. Antidysrhythmia medications are used to convert atrial flutter to sinus rhythm (e.g., ibutilide) or to maintain sinus rhythm (e.g., amiodarone flecainide, dronedarone). β-blockers slow impulse conduction at AV node and improve the dysrhythmia. Anticoagulation therapy is an optional treatment used for atrial fibrillation to prevent formation of blood clots. Anticholinergics may be used to treat sinus bradycardia.
The nurse provides education to a group of nursing students about cardiac conditions that are common causes of dysrhythmias. What should the nurse include in the teaching? Select all that apply. 1 Valve disease 2 Emotional crisis 3 Conduction defects 4 Accessory pathways 5 Electrolyte imbalances
-Valve disease -Conduction defects -Accessory pathways Dysrhythmia is a condition of abnormal heart rhythm caused by either abnormal conduction or abnormal formation of heart impulses. Several conditions are responsible for the development of dysrhythmia. The cardiac disorders that may lead to dysrhythmia involve valve disease, conduction defects, and accessory pathways. Emotional crisis and electrolyte imbalances are noncardiac conditions that may cause a dysrhythmia.
The nurse is preparing an initial care plan for a patient that presents with chest pain. What is the priority nursing intervention? 1 Monitoring the patient's ECG 2 Discussing the losses associated with chronic illness 3 Encouraging verbalization of feelings, perceptions, and fears 4 Advising the patient to avoid heavy meals and extreme weather conditions
1 Monitoring the patient's ECG
A patient with a diagnosis of unstable angina is admitted to the intensive care unit. The nurse anticipates that which drug therapies will be prescribed? Select all that apply. 1 Nitrates 2 Antiplatelet therapy 3 Anticoagulant therapy 4 Beta-adrenergic blockers 5 Angiotensin-converting enzyme (ACE) inhibitors
1 Nitrates 2 Antiplatelet therapy 3 Anticoagulant therapy Nitrates are the first line of drug therapy for angina because of their mechanisms of dilating peripheral blood vessels to reduce cardiac workload and dilating the coronary arteries and collateral vessels to increase blood flow to ischemic areas of the heart. Antiplatelet therapy works in different ways to inhibit platelet activation and aggregation. Anticoagulants have several different mechanisms of action to prevent the formation of fibrin and thrombin and interfere with formation of clotting factors. Beta-adrenergic blockers are commonly used in the treatment of chronic stable angina and acute coronary syndrome. ACE inhibitors are used for heart failure, tachycardia, myocardial infarction, hypertension, diabetes, and chronic kidney disease.
When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? 1 Oxygen, nitroglycerin, aspirin, and morphine 2 Aspirin, nitroprusside, dopamine, and oxygen 3 Nitroglycerin, lorazepam, oxygen, and warfarin 4 Oxygen, furosemide, nitroglycerin, and meperidine
1 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 provides basic physical activity guidelines for a patient that is being discharged following acute coronary syndrome (ACS). The nurse recommends following the FITT formula, which includes which guidelines? 1 Physical activity that is regular, rhythmic, and repetitive 2 An increase in heart rate of 25 beats/minute over the resting heart rate 3 Physical activity sessions that begin at 5 to 10 minutes and build up to 45 minutes. 4 Mild weightlifting for 10 minutes to allow stretching of muscles before exercising
1 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 heart rate (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.
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? 1 "A symptom of major bleeding with thrombolytic therapy is an increase in heart rate." 2 "Significant facial trauma within the past 3 months is a relative contraindication." 3 "The goal is to give the thrombolytic within 30 minutes of the patient's arrival to the emergency department." 4 "The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG."
2 "Significant facial trauma within the past 3 months is a relative contraindication."
The nurse is providing teaching to a patient recovering from a myocardial infarction (MI). How should resumption of sexual activity be discussed? 1 Delegated to the health care provider 2 Discussed along with other physical activities 3 Avoided because it is embarrassing to the patient 4 Accomplished by providing the patient with written material
2 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 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.
While explaining temporary pacemakers to a group of nursing students, what should the nurse include? Select all that apply. 1 All temporary pacemakers are transvenous. 2 Epicardial pacing involves attaching leads to the epicardium during heart surgery. 3 A transvenous pacemaker consists of leads that are threaded into the left ventricle. 4 Epicardial pacemakers are inserted in emergency departments and critical care units in emergency situations. 5 A transvenous pacemaker is attached to an external power source. 6 The placement of a transcutaneous pacemaker is noninvasive; it is a temporary procedure.
2) Epicardial pacing involves attaching leads to the epicardium during heart surgery. 5) A transvenous pacemaker is attached to an external power source. 6) The placement of a transcutaneous pacemaker is noninvasive; it is a temporary procedure. Epicardial pacing wires are inserted into the epicardial wall of the heart during cardiac surgery. The wires are brought through the chest wall and can be connected to a pulse generator if needed. Four wires are placed through the chest wall of the patient, two wires from the atrium and two wires from the ventricles. These four wires are connected to the temporary pacemaker, and pacing thresholds are set for each patient. With transvenous pacemakers, a pacing catheter is inserted percutaneously into the right ventricle, where it gets connected to the endocardium near the ventricular septum. It is connected to a small external pulse generator by electrode wires. Placement of the transcutaneous pacemaker is noninvasive and a temporary method until a more permanent treatment is sought. Transcutaneous pacemakers use electrical stimulation that is delivered through the skin via external electrode pads connected to an external pacemaker (a defibrillator with pacemaker functions). Temporary pacemakers include transcutaneous pacemakers, transvenous pacemakers, and epicardial pacemakers.
An experienced nurse teaches a group of new graduate nurses about temporary pacemakers. What should the nurse include about indications for a temporary pacemaker? Select all that apply. 1 Heart failure 2 Prophylaxis after open heart surgery 3 Atrial fibrillation with slow ventricular response 4 Acute anterior myocardial infarction (MI) with second- or third-degree AV block 5 Acute inferior myocardial infarction (MI) with symptomatic bradycardia and AV block
2) Prophylaxis after open heart surgery 4) Acute anterior myocardial infarction (MI) with second- or third-degree AV block 5) Acute inferior myocardial infarction (MI) with symptomatic bradycardia and AV block A temporary pacemaker helps to maintain the normal pace of the heart when its electrical pathways are damaged. The power source of this device is placed outside the body. Temporary pacemakers are used after open heart surgery as prophylaxis. They are also indicated for use in patients with acute anterior MI with second- or third-degree heart block or bundle branch block. Indications also include for a patient with They are also indicated for patients with acute inferior myocardial infarction (MI) with symptomatic bradycardia and AV block. Heart failure and atrial fibrillation are not indications for a temporary pacemaker.
A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse include when discussing physical activity? 1 "Start out with 30-minute sessions." 2 "Be sure to perform physical activity at least twice a week." 3 "Physical activity should be regular, rhythmic, and repetitive." 4 "Your heart rate during exercise should only go up to 30 beats over your resting heart rate."
3 "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/minute over the resting heart rate.
A patient experiences prolonged chest pain that is not immediately reversible. The patient's health care provider explains that the cause of the pain is that a once-stable atherosclerotic plaque has ruptured, causing platelet aggregation and thrombus formation. The nurse recognizes this meets the definition of what diagnosis? 1 Unstable angina 2 Acute coronary syndrome (ACS) 3 ST segment elevation myocardial infarction (STEMI) 4 Non-ST segment elevation myocardial infarction (NSTEMI)
Acute coronary syndrome (ACS) When ischemia is prolonged and not immediately reversible, ACS develops. ACS is associated with deterioration of a once stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as STEMI.
For which problem is percutaneous coronary intervention (PCI) most clearly indicated? 1 Chronic stable angina 2 Left-sided heart failure 3 Acute myocardial infarction 4 Coronary artery disease (CAD)
Acute myocardial infarction PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD normally are treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.
The nurse notes that a patient's medication history includes clopidogrel. The nurse recognizes that this medication belongs to which drug class? 1 Antiplatelet 2 Opioid analgesic 3 Vitamin K antagonist 4 Nonsteroidal antiinflammatory drug (NSAID)
Antiplatelet
A patient reports chest pain. The nurse should assess for which clinical manifestations associated with a myocardial infarction (MI)? Select all that apply. 1 Flushing 2 Ashen skin 3 Diaphoresis 4 Nausea and vomiting 5 S3 or S4 heart sounds
Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds 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 (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.
The nurse is caring for a patient with a myocardial infarction. The health care provider prescribes an intravenous infusion of alteplase. What is the priority nursing intervention during the administration of this medication? 1 Assess neurologic status. 2 Observe for bleeding gums. 3 Monitor blood pressure for orthostatic changes. 4 Apply a pressure dressing to intravenous (IV) insertion site.
Assess neurologic status. Assessment for changes in neurologic status is the priority nursing intervention because this may indicate a cerebral bleed. Gingival or bleeding gums are expected with thrombolytic therapy and are controlled by applying ice packs. Application of a pressure dressing to the IV insertion site is not done until evidence of bleeding is noted. Monitoring blood pressure for orthostatic changes is necessary with the use of short-acting nitrates.
The nurse is caring for a patient that is experiencing symptomatic sinus bradycardia. Which drugs are used to treat this rhythm? Select all that apply. 1 Atropine 2 Dopamine 3 Adenosine 4 Metoprolol 5 Epinephrine
Atropine Dopamine Epinephrine Sinus bradycardia is a condition in which the sinoatrial node elicits a heartbeat at a rate of less than 80 beats per minute. Sinus bradycardia is associated with hypotension, weakness, dizziness, and shortness of breath. It can be treated by the administration of atropine, an anticholinergic drug. Sympathomimetic drugs like dopamine and epinephrine are administered if atropine is ineffective. Beta blockers like adenosine and metoprolol are used in the treatment of sinus tachycardia.
The nurse provides a list of health-promoting regular physical activity examples to a patient with coronary artery disease (CAD). Which activity is appropriate to be included on the list? 1 Painting while seated 2 Performing carpentry 3 Jogging (7 to 8 miles per hour) 4 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 three to four miles per hour. Painting while seated is a low-energy activity. Carpentry and running at seven miles per hour are high-energy activities for a patient with acute coronary syndrome.
The nurse monitors a patient for complications of myocardial infarction. The nurse auscultates a new murmur at the cardiac apex. Which treatment strategies are appropriate for inclusion in the patient's care plan? Select all that apply. 1 Antiplatelets 2 Short-term corticosteroids 3 Cardiac surgery with mitral valve repair 4 Intraaortic balloon pump (IABP) therapy 5 Nonsteroidal antiinflammatory agents (NSAIDs)
Cardiac surgery with mitral valve repair Intraaortic balloon pump (IABP) therapy Papillary muscle dysfunction is a complication of myocardial infarction and should be suspected if a new murmur at the cardiac apex is detected. It may occur if the infarcted area includes or is near the papillary muscle that attaches the mitral valve. The patient should be treated with nitroprusside, intraaortic balloon pump (IABP) therapy, or cardiac surgery with mitral valve repair to reduce the afterload of the heart. Antiplatelets, such as aspirin and nonsteroidal antiinflammatory agents, help treat acute pericarditis. Short-acting corticosteroids are effective in the treatment of Dressler syndrome.
Diagnostic results of a patient indicate three-vessel coronary artery disease and the presence of cardiac-specific troponin I (cTnI) and cardiac-specific troponin T (cTnT) markers. The nurse identifies that which intervention will benefit the patient? 1 Placement of drug-eluting stents 2 Percutaneous coronary intervention 3 Intraaortic balloon pump (IABP) therapy 4 Coronary revascularization with coronary artery bypass graft (CABG) surgery
Coronary revascularization with coronary artery bypass graft (CABG) surgery Coronary revascularization with CABG surgery helps restore the blood flow to the heart by replacing new blood vessels around existing blockages. This procedure is best for a patient with diabetes and three-vessel disease because it helps improve perfusion to the myocardial muscle. A patient with confirmed myocardial infarction needs the placement of drug-eluting stents via cardiac catheterization. Percutaneous coronary intervention is a first line of treatment for a patient with definitive electrocardiogram changes and positive cardiac markers. Intraaortic balloon pump (IABP) therapy is used to treat severe left ventricular dysfunction.
The nurse is caring for a patient one month after the patient's cardiac surgery. The patient is hospitalized with a three-day history of chest pain, joint pain, and a body temperature of 101°F. 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 does the nurse suspect? 1 Pneumonia 2 Hiatal hernia 3 Dressler syndrome 4 Ventricular aneurysm
Dressler syndrome Dressler syndrome is pericarditis that develops four to six weeks after cardiac surgery. 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.
The nurse is preparing a patient for an electrocardiogram (ECG). When placing the six unipolar chest leads, at what position should the nurse place the V 6 lead? 1 Fifth intercostal space at the left midaxillary line 2 Fifth intercostal space at the left midclavicular line 3 Fifth intercostal space at the left anterior axillary line 4 Fourth intercostal space at the right sternal border
Fifth intercostal space at the left midaxillary line The V6 lead should be placed at the fifth intercostal space at the left midaxillary line. The V4 lead is placed at the fifth intercostal space at the left midclavicular line. The V5 lead is placed at the fifth intercostal space at the left anterior axillary line. The V1 lead is placed at the fourth intercostal space at the right sternal border.
A patient experienced sudden cardiac death (SCD) while hospitalized and survived. The nurse expects that what preventive treatment will be prescribed? 1 External pacemaker 2 An electrophysiologic study (EPS) 3 Medications to prevent dysrhythmias 4 Implantable cardioverter-defibrillator (ICD)
Implantable cardioverter-defibrillator (ICD) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital, but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used, but are not best for prevention of SCD.
A patient survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence? 1 Drug therapy with beta-blocker 2 Coronary artery bypass graft (CABG) 3 Percutaneous coronary intervention (PCI) 4 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 coronary artery bypass graft is not necessary.
The nurse recognizes that which type of myocardial infarction (MI) may occur due to blockage of the right coronary artery? 1 Inferior wall MI 2 Anteroseptal MI 3 Anterolateral MI 4 Anterior wall MI
Inferior wall MI Blockage of the right coronary artery may result in an inferior wall myocardial infarction (MI) because the right coronary artery supplies blood to the inferior wall of the heart. Damage to one or more coronary arteries may result in anteroseptal and anterolateral MIs. Anterior wall infarctions result from blockages in the left anterior descending artery.
The nurse recalls that which artery is most commonly used for bypass graft? 1 Radial artery 2 Gastroepiploic artery 3 Inferior epigastric artery 4 Internal mammary artery
Internal mammary artery 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 percent after 10 years. Procedures involving the radial, gastroepiploic, or inferior epigastric artery have a comparatively short-term patency rate.
A patient with Prinzmetal's angina who takes a short-acting nitrate reports feeling dizzy while changing positions. What prescription does the nurse anticipate? 1 Esmolol 2 Morphine sulfate 3 Intravenous heparin 4 Intravenous fluid bolus
Intravenous 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 must be administered intravenous fluid bolus. Beta blockers such as esmolol can lead to hypotension, which may further worsen the patient's condition. Intravenous 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 has received a maximum dose of nitroglycerin continues to report chest pain. What is the next medication that the nurse should administer to the patient? 1 Esmolol 2 Docusate 3 Ticagrelor 4 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 beta 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 blood pressure is 130/86 mm Hg, heart rate is 102 beats/minute, respiratory rate is 24 breaths/minute, and the fingerstick blood glucose is 136 mg/dL. The nurse recognizes that the patient is experiencing what? 1 Myocardial infarction 2 Late-stage diabetic ketoacidosis 3 Early-onset diabetic ketoacidosis 4 Hyperosmolar hyperglycemic nonketotic syndrome
Myocardial infection Signs and symptoms of a myocardial infarction (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. Only cool, clammy skin is indicative of hypoglycemia.
Cardiac biomarker levels are being evaluated for a patient who is suspected of having a myocardial infarction (MI). The nurse recognizes that which biomarker lacks specificity and that its role in diagnosing an MI is limited? 1 Myoglobin 2 Creatine kinase-MB (CKMB) 3 Cardiac-specific troponin I (cTnI) 4 Cardiac-specific troponin T (cTnT)
Myoglobin Myoglobin is a serum cardiac marker that is released into the circulation within two hours after a myocardial infarction (MI). Myoglobin's role in diagnosing MI is limited because it lacks cardiac specificity. Creatine kinase-MB (CKMB) 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.
The nurse is examining the 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? 1 Sinus tachycardia 2 Pathologic Q wave 3 Fibrillatory P waves 4 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.
The nurse recalls that coronary revascularization with coronary artery bypass graft (CABG) surgery is recommended for which patients? Select all that apply. 1 Patients with severe aortic stenosis 2 Patients who fail medical management 3 Patients with left main coronary artery or three-vessel disease 4 Patients who are not candidates for percutaneous coronary intervention (PCI) 5 Patients who have failed percutaneous coronary intervention (PCI) and continue to have chest pain
Patients who fail medical management Patients with left main coronary artery or three-vessel disease Patients who are not candidates for percutaneous coronary intervention (PCI) Patients who have failed percutaneous coronary intervention (PCI) and continue to have chest pain Coronary revascularization with CABG is recommended for patients who have diabetes mellitus, have left main coronary artery or three-vessel disease, patients who are not candidates for percutaneous intervention and who have failed percutaneous intervention and continue to have chest pain, and those who are expected to have longer-term benefits with this surgery than with catheterization. Severe aortic stenosis is not an indicator for cardiac revascularization surgery.
A patient experiences mild chest pain during inspiration, while coughing, and while performing daily activities. Sitting in a forward position relieves the pain. The nurse identifies that the patient is experiencing what complication of myocardial infarction? 1 Pericarditis 2 Left-sided heart failure 3 Ventricular aneurysm 4 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. Left-sided heart failure occurs initially with subtle signs such as mild dyspnea, restlessness, agitation, or slight tachycardia. A ventricular aneurysm may result from thinning of the infarcted myocardial walls. Papillary muscle dysfunction occurs when the infarcted area includes the papillary muscle that attaches to the mitral valve.
The nurse is reviewing a plan of care for emergency treatment of a patient with chest pain. The nurse should question which item listed on the plan? 1 Give a high-dose statin. 2 Give 162 to 325 mg aspirin (chewable). 3 Start O 2 by nasal cannula to keep O 2 saturation above 93%. 4 Provide the patient with instructions related to cough and deep breathing exercises.
Provide the patient with instructions related to cough and deep breathing exercises. Rapid diagnosis and providing treatment to a patient with acute coronary syndrome help 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 LDL receptors in the liver.
The nurse observes a student nurse who is providing thrombolytic therapy to a patient three hours after the patient's report of chest pain. Which action performed by the student nurse indicates the need for the nurse to intervene? 1 Monitors the patient for blood in the urine 2 Assesses the patient regularly for neurologic status changes 3 Draws blood samples from the patient before initiation of the therapy 4 Reduces the dose of the thrombolytic agent during episodes of chest pain
Reduces the dose of the thrombolytic agent during episodes of chest pain Thrombolytic therapy helps stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium. In order to be effective, the entire dose of a thrombolytic agent must be administered as soon as possible after the onset of symptoms. Unless contraindicated, the patient should be provided with heparin intravenously (IV) along with other thrombolytic therapy to dissolve the unstable thrombus and reduce spasms in the coronary artery. A major complication of the thrombolytic therapy is bleeding; therefore the nurse should monitor the urine and stool for bleeding. Monitoring for neurologic changes in the patient helps assess for cerebral bleeding. The nurse should draw the blood samples from the patient before initiation of the therapy to assess the baseline laboratory values.
After being identified as high risk for traditional bypass surgery, a patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB). The nurse recognizes that which steps are involved in the procedure? Select all that apply. 1 A robot is used to replace the mitral valve. 2 Small incisions are made between the ribs. 3 Cardiac catheterization is performed during the procedure. 4 A mechanical stabilizer is placed to immobilize the operative site. 5 A thoracoscope or robotic assistance is used to dissect the internal mammary artery from the chest.
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 dissect the internal mammary artery from the chest. Minimally invasive direct coronary artery bypass (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 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. The nurse should question which item that was included in the education? 1 "Most side effects subside with time." 2 "Take the drug on an empty stomach." 3 "Decreased liver function may occur with high doses." 4 "A side effect is flushing and pruritus in the upper torso and face."
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.
A patient asks the nurse about resuming sexual activity after acute coronary syndrome (ACS). What should the nurse include in the patient's teaching plan? 1 Take a hot shower just before intercourse to provide relaxation. 2 Limit the time, including foreplay, to 30 minutes to prevent overexertion. 3 Wait an hour after ingesting a large meal before engaging in sexual activity. 4 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 3-4 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 arrives in the emergency room with indigestion, shortness of breath, and back pain. The nurse reviews the results of the patient's 12-lead electrocardiogram (ECG) and notes ST elevation in leads II, III, and AVF. How should the nurse interpret the findings? 1 The patient has acute injury to the circumflex artery. 2 The patient has acute injury to the right coronary artery. 3 The patient has acute infarction of the left anterior descending artery. 4 The patient is not having a heart attack and most likely has gastric reflux.
The patient has acute injury to the right coronary artery. An ST elevation in leads II, III, and AVF indicates an acute injury to the inferior wall of the left ventricle involving the right coronary artery. An ST elevation in leads V1-V4 indicates acute infarction of the septal or anterior wall of the left ventricle involving the circumflex and left anterior descending arteries. An ST elevation with T wave inversion and a pathologic Q wave indicate acute infarction with cardiac cell death. A patient with symptoms of indigestion, shortness of breath, and back pains should have an immediate 12-lead ECG to rule out cardiac involvement; these symptoms indicate something more severe than reflux.
A patient tells the nurse, "I had severe chest pain six days ago." The nurse identifies that which cardiac biomarker will be most helpful in determining whether the patient had a myocardial infarction at the time the patient experienced chest pain? 1 Troponin 2 Myoglobin 3 Homocysteine 4 Creatine kinase
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.
