Cardiovascular Alterations CC Questions
The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find? a. Dependent edema b. Distended neck veins c. Dyspnea and crackles d. Nausea and vomiting
C In left-sided heart failure, signs and symptoms are related to pulmonary congestion. Dependent edema and distended neck veins are related to right-sided heart failure.
A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. He is nauseous and diaphoretic, and his skin is dusky in color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question? a. Emergent pacemaker insertion b. Emergent percutaneous coronary intervention c. Emergent thrombolytic therapy d. Immediate coronary artery bypass graft surgery
A The goals of management of AMI are to dissolve the lesion that is occluding the coronary artery and to increase blood flow to the myocardium. Options include emergent percutaneous intervention, such as angioplasty, emergent coronary artery bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for less than 6 hours. No data in this scenario warrant insertion of a pacemaker.
The nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the critical care nurse? a. "My back is killing me!" b. "There is blood on my toothbrush!" c. "Look at the bruises on my arms!" d. "My arm is bleeding where my IV is!"
A The nurse must continually monitor for clinical manifestations of bleeding. Mild gingival bleeding and oozing around venipuncture sites are common and not a cause for concern. Severe lower back pain and ecchymoses are suggestive of retroperitoneal bleeding. If serious bleeding occurs, all fibrinolytic heparin therapies must be discontinued, and volume expanders or coagulation factors, or both, are administered.
A patient presents to the ED complaining of severe substernal chest pressure radiating to his left shoulder and back that started about 12 hours ago. The patient delayed coming to the ED since he was hoping the pain would go away. The patient's 12-lead ECG shows ST-segment depression in the inferior leads. Troponin and CK-MB are both elevated. The hospital does not have the capability for percutaneous coronary intervention. Thrombolysis is one possible treatment. Based on these data, the nurse understands that? a. The patient is not a candidate for thrombolysis. b. The patient's history makes him a good candidate for thrombolysis. c. Thrombolysis is appropriate for a candidate having a non-Q wave MI. d. Thrombolysis should be started immediately.
A To be eligible for thrombolysis, the patient must be symptomatic for less than 6 hours.
A patient is admitted with an acute myocardial infarction (AMI). The nurse monitors for which potential complications? (Select all that apply.) a. Cardiac dysrhythmias b. Heart failure c. Pericarditis d. Ventricular rupture
A, B, C, D All are potential complications of AMI.
The patient's wife is feeling overwhelmed and tells the nurse that she doesn't know if she can manage to cook different dinners for her husband and the rest of the family to satisfy his cholesterol-reducing diet. The nurse tells her: a. "It will be worth it to have him healthy, won't it?" b. "The low-cholesterol diet is one from which everyone can benefit." c. "As long as you change at least a few things in the diet, it will be okay." d. "You can go on the diet with him, and then just let the children eat whatever they want."
B Some cardiologists advocate a reduction of the low-density lipoprotein goal to the 50 to 70 mg/dL range for everyone, not only those with a known cardiovascular disease.
The patient is admitted with an acute myocardial infarction (AMI). Three days later the nurse is concerned that the patient may have a papillary muscle rupture. Which assessment data may indicate a papillary muscle rupture? a. Gallop rhythm b. Murmur c. S1 heart sound d. S3 heart sound
B The presence of a new murmur warrants special attention, particularly in a patient with an AMI. A papillary muscle may have ruptured, causing the valve to close incorrectly, which can be indicative of severe damage and impending complications.
Which nursing interventions would be appropriate after angioplasty? (Select all that apply.) a. Elevate the head of the bed by 45 degrees for 6 hours b. Assess pedal pulses on the involved limb every 15 minutes for 2 hours c. Monitor the vascular hemostatic device for signs of bleeding d. Instruct the patient bend his/her knee every 15 minutes while the sheath is in place
B, C, D The head of the bed must not be elevated more than 30 degrees, and the patient should be instructed to keep the affected leg straight. Bed rest is 6 to 8 hours in duration, unless a vascular hemostatic device is used. The nurse observes the patient for bleeding or swelling at the puncture site and frequently assesses adequacy of circulation to the involved extremity.
To increase patient compliance and reduce postoperative complications, the nurse should include which of the following topics in the preoperative teaching for a patient who is to have a coronary artery bypass graft (CABG)? (Select all that apply.) A) Reasons for cooling blankets in post-op period B) Equipment used: IVs, Foley, pacer wires, chest tubes, NG tubes, ECG leads C) Drug management: need for sedation when intubated, pain med through PCA D) Alternate methods for communicating when intubated E) Reasons and techniques of turning, coughing, and deep-breathing once extubated
B, C, D, E The more information that is given to the patient, the less the patient is anxious because psychological and physical stress will increase oxygen demand. The element of surprise or the unknown is reduced when explanations and anticipation of concerns are addressed prior to their occurrence. #1 is incorrect. During surgery hypothermia results and heating blankets, not cooling blankets, are used to stabilize core body temperatures. A cooling blanket might be needed if the patient spikes a high fever, but this is not a common post-op complication.
Which of the following findings should cause the nurse to suspect that a post coronary artery bypass patient might be developing cardiac tamponade? (Select all that apply.) A) Widening pulse pressure B) Increased jugular vein distension C) Decreasing central venous pressure (CVP) D) Lack of pleural (chest) tube drainage E) Muffled heart sounds
B, D, E Fluid ceases to drain from the pericardial tubes into the pleural (chest) tubes. As the heart is compressed within its own pericardial sac from fluid accumulation, the ability to expand is limited because fluid accumulates outside the heart to the point in which contraction cannot occur. The pressures back up and create increased pressure as seen with engorging jugular veins. The fluid surrounding the heart muffles the heart sounds. #1 is incorrect. The pulse pressure will narrow, not widen, as less pressure differences are noted between the systolic and diastolic pressures. #3 is incorrect. The CVP increases not decreases as the backup occurs when the ventricles cannot pump and circulate the blood due to its limited motion.
Which of the following would be most helpful to the nurse in determining whether the chest pain of a patient who has just entered the emergency department is cardiac in origin? A) Gathering a complete medical history B) Performing a 12-lead ECG C) Administering NTG to see if the pain goes away D) Asking the patient if performing a Valsalva maneuver reduces the pain
B. A 12-lead ECG is performed immediately if the symptoms are suggestive of pain that is cardiac in origin. #1 is incorrect. Reviewing a complete history will waste time in what might be an emergent situation. #3 is incorrect. Just experimenting with a drug such as NTG should not be the first choice for differentiating the source of the chest pain. Also it is unethical to give a drug without a specific reason or cause. #4 is incorrect. Performing the Valsalva maneuver will increase abdominal and thoracic pressures and can cause vagal stimulation that will result in decreased heart rate. It should not be suggested unless tachycardia is present and emergency equipment is available in case of cardiac arrest. This is not a method of differentiating the types of chest pain.
A patient tells a nurse, My chest pain starts when I am resting and when I had a cardiac catheterization, the doctor said I was having vasospasms; Which of the following types of medications would the nurse anticipate would be utilized to treat the patients angina? A) A vasodilator such as nitroglycerin (NTG) B) A calcium channel blocking agent C) An antidysrhythmic such as lidocaine D) A beta adrenergic blocking agent
B. Calcium channel blocking agents would be the drug of choice to stop the spasms of the coronary arteries that are causing the hypoxic pain in the myocardium from Prinzmetal angina. #1 is incorrect. NTG is used with stable angina, not Prinzmetal angina. #3 is incorrect. Lidocaine IV push will treat cardiac dysrhythmias but not hypoxic pain or coronary vasospasm. #4 is incorrect. Beta adrenergic blocking agents are used to treat stable angina.
The nurse is discussing the Dietary Approaches to Stop Hypertension (DASH) program with a patient and his spouse. They are overwhelmed and ask if there is one measure recommended by the program that would have the biggest impact so they can start with that measure first. The nurse should suggest: A) Controlling diabetes to an A1C less than 7%. B) Decreasing their sodium intake to less than 1,500 mg/day. C) Increasing their intake of dairy products. D) Losing weight.
B. Dropping sodium intake to 1,500 mg per day results in the largest reduction in BP.
A nurse is teaching a patient with coronary artery disease about his prescribed nitroglycerin therapy. Which of the following statements, if made by the patient, would indicate that he needs further teaching? A) I should not take nitroglycerin if I have taken Viagra. B) I'll put a couple of tablets in a plastic bag in my pocket so I have them with me all the time. C) If the pain doesnt go away I can take a second tablet after 5 minutes. D) I should try to sit or lie down when I take the nitroglycerin.
B. This is an incorrect response, which is what the question is looking for. Commonly used medication is nitroglycerin. Nitroglycerin should be kept in a tightly sealed brown bottle.
A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzymes (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process? a. Myocardial stunning b. Hibernating myocardium c. Myocardial remodeling d. Tachycardia
C Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors reduce the incidence of remodeling.
The patient is admitted with recurrent supraventricular tachycardia that the cardiologist believes to be related to an accessory conduction pathway or a reentry pathway. The nurse anticipates which procedure to be planned for this patient? a. Implantable cardioverter-defibrillator placement b. Permanent pacemaker insertion c. Radiofrequency catheter ablation d. Temporary transvenous pacemaker placement
C Radiofrequency catheter ablation is a method of interrupting a supraventricular tachycardia, a dysrhythmia caused by a reentry circuit, and an abnormal conduction pathway.
A 72-year-old woman is brought to the ED by her family. The family states that she's "just not herself." Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions (PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST segments in leads II, III, and AVF. The nurse knows that these symptoms are most likely associated with which diagnosis? a. Hypokalemia b. Non-Q wave MI c. Silent myocardial infarction d. Unstable angina
C Some individuals may have ischemic episodes without knowing it, thereby having a "silent" infarction. These can occur with no presenting signs or symptoms. Asymptomatic or nontraditional symptoms are more common in elderly persons, in women, and in diabetic patients.
The patient presents to the ED with sudden severe sharp chest discomfort radiating to his back and down both arms, as well as numbness in his left arm. While taking the patient's vital signs, the nurse notices a 30-point discrepancy in systolic blood pressure between the right and left arm. Based on these findings, the nurse should: a. contact the physician and report the cardiac enzyme results. b. contact the physician and prepare the patient for thrombolytic therapy. c. contact the physician immediately and begin prepping the patient for surgery. d. give the patient aspirin and heparin.
C These symptoms indicate the possibility of acute aortic dissection. Symptoms often mimic those of AMI or pulmonary embolism. Aortic dissection is a surgical emergency. Signs and symptoms include chest pain and arm paresthesia.
An 80-year- old woman has arrived in the ED. The ED physician is questioning whether she has had an MI although she is not displaying the classic chest pain. Which of the following symptoms might cause him to suspect that she was experiencing an MI? A) Jaw and/or tooth pain B) Confusion accompanied by hypotension C) Generalized fatigue accompanied by dyspnea and diaphoresis D) Dyspnea accompanied by crackles in all lobes
C. Coronary symptoms in women include fatigue, diaphoresis, and nonspecific pain that is different than that identified by men. #1 is incorrect. This is a symptom of cardiac disease and can occur in men and women, so it is not a differential for women. #2 is incorrect. Centralized chest pain is more likely to occur in men than in women. #4 is incorrect. Rales are evidence of fluid backup in the pulmonary system as seen in congestive heart failure. Both genders can have dyspnea and, therefore, it is not a differential factor.
A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient? a. Bile acid resins b. Nicotinic acid c. Nitroglycerin d. Statins
D The statins have been found to lower low-density lipoproteins (LDLs) more than other types of lipid-lowering drugs.
Which of the following lab findings would the nurse review to validate a diagnosis of a myocardial infarction (MI) that was suspected of occurring approximately 3 hours earlier? A) CK B) Troponin T assay C) Myoglobin D) PTT
C. Myoglobin will peak between 1 and 4 hours after the hypoxic/necrotic event and return to normal in 24 hours. Therefore, it is the first to rise when tissue damage has occurred. #1 is incorrect. Creatinine phosphokinase (CK) serum levels peak between 12 and 14 hours and return to normal after 72 to 96 hours. Therefore, it would not help during the first few hours to validate an MI. #2 is incorrect. Troponin T assay is the most sensitive for cardiac damage but does not appear in the bloodstream until 4 to 12 hours after the damage occurs. It returns to normal after 4 to 10 days. #4 is incorrect. PTT does not measure tissue damage; it measures serum clotting times for anticoagulant therapy. Therefore, it would not validate when or if an MI occurred.
A patient with coronary artery disease is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers? a. 12-lead electrocardiogram b. Cardiac catheterization c. Echocardiogram d. Electrophysiology study
C Echocardiography is a noninvasive, acoustic imaging procedure and involves the use of ultrasound to visualize the cardiac structures and the motion and function of cardiac valves and chambers.
The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction(MI)? a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels b. Depressed ST-segment on ECG and elevated total CPK c. Depressed ST-segment on ECG and normal cardiac enzymes d. Q wave on ECG with normal enzymes and troponin levels
A ST segment elevation and elevated cardiac enzymes are seen in Q wave MI.
The patient has been in chronic heart failure for the past 10 years. He has been treated with beta-blockers and angiotensin-converting enzyme inhibitors as well as diuretics. His symptoms have recently worsened, and he presents to the ED with severe shortness of breath and crackles throughout his lung fields. His respirations are labored and arterial blood gases show that he is at risk for respiratory failure. Which of the following therapies may be used for acute, short-term management of the patient? (Select all that apply). a. Dobutamine b. Intraaortic balloon pump c. Nesiritide (Natrecor) d. Ventricular assist device
A, B, C Patient is showing signs and symptoms of an acute exacerbation of heart failure. Dobutamine and nesiritide are medications administered for acute short-term management; mechanical assist with an intraaortic balloon pump also may be warranted.
Identify the priority interventions for managing symptoms of an acute myocardial infarction (AMI) in the ED. (Select all that apply). a. Administration of morphine b. Administration of nitroglycerin (NTG) c. Dopamine infusion d. Oxygen therapy
A, B, D The initial pain of AMI is treated with morphine sulfate administered intravenously. NTG may be given to reduce the ischemic pain of AMI. NTG increases coronary perfusion because of its vasodilatory effects. Oxygen administration is important for assisting the myocardial tissue to continue its pumping activity and for repairing the damaged tissue around the site of the infarct.
When assessing the risk for stress ulcers after a coronary artery bypass graft (CABG) surgery, which factors would contribute to this risk? (Select all that apply.) A) Alcohol abuse or excess B) Age less than 70 years C) Incidence of postoperative hemorrhaging D) Need for vasodilators for postoperative hypertension E) Prolonged use of CRB
A, C, E The potential for liver damage and bleeding disorders are increased risks for stress ulcers in the postoperative period. #2 is incorrect. The age for increased risk is over 70 years old, not under 70. #4 is incorrect. The criteria for an increased risk are for those patients who have received a vasoconstrictor, not a vasodilator.
The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia? a. Second degree heart block b. Atrial fibrillation or flutter c. Ventricular ectopy d. Premature junctional contractions
B Atrial fibrillation and flutter are dysrhythmias common after cardiac surgery.
The patient's wife is confused about the scheduling of a stent insertion. She says that she thought the angioplasty was surgery to fix her husband's heart problem. The nurse explains to her: a. "The angioplasty was a failure, and so this procedure has to be done to fix the heart vessel." b. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again." c. "This procedure is being done instead of using clot-dissolving medication to help keep the heart vessel open." d. "The stent will remove any clots that are in the vessel and protect the heart muscle from damage."
B Stents are inserted to optimize the results of other treatments for acute vessel closure (percutaneous transluminal coronary angioplasty, atherectomy, fibrinolytics) and to prevent restenosis.
A patient is being discharged after an MI taking lisinopril 10 mg daily. Which of the following instructions is most appropriate for the nurse to give to the patient? A) Avoid crossing your legs B) Change your position slowly when going from lying to sitting C) Cut down on your sodium intake to 1,500 mg/day D) Weigh yourself at least three times a week
B. Watching for postural hypotension when initiating therapy is important. Monitoring blood pressure before dosing and holding per agency protocol if BP is too low. The most common adverse effects are hypotension (which occurs most commonly in patients who are hyponatremic).
The patient's wife asks the nurse if the angioplasty will remove all the buildup in the vessel walls so that the patient will be healthy again. The nurse explains: a. "The operation will remove all of the plaque, and if your husband exercises and diets he will be free of cardiac problems." b. "The surgery will remove all the buildup, but it will reaccumulate and he will probably need this surgery again this time next year." c. "The best outcome will be if 20% to 50% of the diameter of the vessel can be restored. Your husband will need to diet and exercise carefully to avoid further cardiac risk." d. "The surgeon will only be able to get 5% to 10% of the plaque, but this will bring about marked relief of your husband's symptoms."
C A successful angioplasty procedure is one in which the stenosis is reduced to less than 50% of the vessel lumen diameter, although most clinicians aim for less than 20% final diameter stenosis.
While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process? a. Coronary artery spasm. b. Decreased blood flow (ischemia). c. Death of cardiac muscle from lack of oxygen (tissue necrosis). d. Sporadic decrease in oxygen to the heart (transient oxygen imbalance).
C Acute myocardial infarction is death (tissue necrosis) of the myocardium that is caused by lack of blood supply from the occlusion of a coronary artery and its branches.
A patient is admitted with an angina attack. The nurse anticipates which drug regimen to be initiated? a. ACE inhibitors and diuretics b. Morphine sulfate and oxygen c. Nitroglycerin, oxygen, and beta-blockers d. Statins, bile acid, and nicotinic acid
C Conservative intervention for the patient experiencing angina includes nitrates, beta-blockers, and oxygen.
The physician orders a pharmacological stress test for a patient with activity intolerance. The nurse would anticipate that the drug of choice would be a. Dopamine b. Dobutamine c. Adenosine d. Atropine
C If a patient is unable physically to perform the exercise, a pharmacological stress test can be done. Adenosine is preferred over dobutamine because of its short duration of action and because reversal agents are not needed.
Acute myocardial infarction (AMI) can be classified as which of the following? (Select all that apply.) a. Angina b. Nonischemic c. Non-Q wave d. Q wave
C, D AMI can be classified as Q wave or non-Q wave.
Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery? a. Right coronary artery b. Left coronary artery c. Circumflex d. Left main coronary artery
D Stenosis of the left mainstem artery is considered unacceptable for percutaneous intervention.
A nurse is evaluating a patients understanding after he was diagnosed with a myocardial infarction. Which of the following would indicate that the patient did not understand important information and needs additional teaching? A) A heart attack is the same as a myocardial infarction (MI). B) A heart attack causes tissue death and that part of the heart may not pump as well. C) A heart attack in the anterior wall of the heart can be very serious because a large portion of the heart may not pump as well. D) Angina always leads first to decreased blood flow to the heart muscle and then to tissue death.
D. Angina pectoris is the pain from ischemia, but necrosis of myocardial tissue does not occur with each episode of pain. The pain is from tissue hypoxia; ischemia areas may improve or deteriorate into necrosis due to collateral circulation from other vessels. #1, #2, and #3 are incorrect responses because all of these statements are correct information. No clarification is needed by the nurse.
A nurse is preparing to administer the first 5-mg dose of metoprolol to a patient who is 12 hours post MI. For which of the following findings should the nurse withhold administration of the medication? A) Blood pressure of 110/65 B) PR interval 0.12 second C) Serum potassium 3.9 mEq/L D) Sinus bradycardia 52 beats per minute
D. Beta blocker therapy is contraindicated when the patient has a heart rate less than 60 beats per minute, systolic blood pressure less than 100 mm Hg, moderate or severe left ventricular failure, shock, PR interval on the electrocardiogram greater than 0.24 second, second- and third-degree heart block, and active asthma and/or reactive airway disease.
A patient has been prescribed nitroglycerin in the ED for chest pain. In taking the health history, the nurse will be sure to verify whether the patient has taken medications prior to admission for: a. Erectile dysfunction b. Prostate enlargement c. Asthma d. Peripheral vascular disease
A A history of the patient's use of sildenafil citrate (Viagra) or similar medications taken for erectile dysfunction is necessary to know when considering NTG administration. These medications potentiate the hypotensive effects of nitrates; thus, concurrent use is contraindicated. It is also important to determine whether the patient has any food or drug allergies
The patient presents to the ED with severe chest discomfort. He is taken for cardiac catheterization and angiography that shows 80% occlusion of the left main coronary artery. Which procedure will be most likely followed? a. Coronary artery bypass graft surgery b. Intracoronary stent placement c. Percutaneous transluminal coronary angioplasty (PTCA) d. Transmyocardial revascularization
A Coronary artery bypass graft surgery is indicated for significant left main coronary occlusion (>50%).
The patient's husband tells the nurse, "We didn't think she was having a heart attack because the pain was in her neck and back." The nurse explains: (Select all that apply.) a. "Pain can occur anywhere in the chest, neck, arms, or back. Don't hesitate to call the emergency medical services if you think it's a heart attack." b. "For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone." c. "The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack." d. "You need to make sure it's a heart attack before you call the emergency response personnel."
A B, C Angina may occur anywhere in the chest, neck, arms, or back, but the most commonly described is pain or pressure behind the sternum. The pain often radiates to the left arm but can also radiate down both arms and to the back, the shoulder, the jaw, and/or the neck.
Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.) a. Jugular venous distention b. Peripheral edema c. Crackles audible in the lungs d. Weak peripheral pulses
A, B Rationale: Jugular venous distention, liver tenderness, hepatomegaly, and peripheral edema are signs of right ventricular failure.
A nurse is discussing management of hypertension with a patient. Which of the following statements by the patient would indicate that the patient needs additional teaching about the relationship between hypertension and acute coronary syndrome (ACS)? A) My high blood pressure has no relationship to the severity of heart disease or its outcomes. B) Because I'm over 80, even a 20 mm Hg drop in my blood pressure can reduce my risk. C) High blood pressure will increase my bodys need for oxygen and increase my hearts workload. D) Controlling my blood pressure will decrease my risk of having a heart attack to some degree.
A. The higher the hypertension rates, the greater the severity of ACS. Therefore, there is a direct correlation between the two. #2, #3, and #4 are incorrect answers to this question. These statements are correct information. Minimal reduction and management of blood pressure will decrease the severity and risk for ACS.
Which comment by the patient indicates a good understanding of her diagnosis of coronary heart disease? a. "I had a heart attack because I work too hard and it puts too much strain on my heart." b. "The pain in my chest gets worse each time it happens. I think that there is more damage to my heart vessels as time goes on." c. "If I change my diet and exercise more, I should get over this and be healthy." d. "What kind of pills can you give me to get me over this and back to my lifestyle?"
B Coronary heart disease is a progressive atherosclerotic disorder of the coronary arteries that results in narrowing or complete occlusion.
A patient says to his nurse, Ive never heard of an acute coronary syndrome. Please explain what happened to me. The nurse should respond, Acute coronary syndrome is: A) Another name for a myocardial infarction (MI) or heart attack B) A group of disorders that result in insufficient oxygen supply to the heart. C) The second leading cause of death in the United States; D) A type of abnormal heart rhythm.
B. This is the definition and/or criteria that guide a diagnosis of ACS. #1 is incorrect. An MI/heart attack is only one of the disorders that falls under this group of disorders. An MI includes tissue necrosis from arterial obstruction. #3 is incorrect. ACS is the number 1 leading cause of death in United States. #4 is incorrect. A cardiac arrest does not always occur when ACS is present. Cardiac arrest is a possibility but it does not occur in every patient.
A patient is admitted with chest discomfort and a possible UA/NSTEMI. Which of the following would be a contraindication to administration of GP-IIb- IIIA inhibitors to the patient? The patient had: A) A platelet count greater than 150,000 mm 3 . B) Major surgery in the last 6 months. C) A stroke within the past month. D) A creatinine level of 1.4 mg/dL.
C. The purpose of this drug is to prevent platelet aggregation by keeping fibrinogen from binding to the GP IIb-IIIA receptors on the platelet surfaces. This condition is a contraindication for giving this drug group because increased bleeding episodes might follow its administration.
When a patient says, The chest pain occurs each time I play basketball; it does not occur when I am sleeping; and it improves when I take those pills under my tongue; the pain will most likely be classified as: A) Variant or Prinzmetals angina. B) Undifferentiated angina. C) Unstable angina. D) Stable angina.
D. Stable angina occurs in a predictable manner, not when resting, and improves with NTG under the tongue. #1 is incorrect. Variant or Prinzmetal angina occurs in an unpredictable pattern that is caused by vasospasm and cause transient ST-segment elevation. These are best treated with calcium channel blockers. #2 is incorrect. There is no such term used to describe angina. #3 is incorrect. Unstable angina does not respond well to nitroglycerin (NTG) and has no set pattern. The pain can occur at rest and with minimal exertion.
A patient starting cardiac rehabilitation will work with the rehabilitation team to meet all of the following goals except: A) Taking control of his life through healthy choices. B) Managing his symptoms by monitoring his exercise. C) Reducing risks by controlling the modifiable risk factors. D) Stabilizing any severe depression that developed post MI.
D. The question is asking which item is not a goal; The need to stabilize emotions, such as depression and anxiety, are addressed but not a major psychiatric disorder, because it would require in-depth individualized counseling. A referral is needed because this is not the goal of the rehabilitation program. #1, #2, and #3 are incorrect responses. They are the goals of the program.
Following angioplasty, a patient develops the following: hematuria,hypotension, tachycardia, a drop in hemoglobin and Hematocrit, and a decrease in oxygen saturation. Which of the following is most likely to be responsible for the symptoms? A) Reaction to vasovagal stimulation B) Myocardial ischemia C) Peripheral emboli distal to the insertion site D) Overanticoagulation
D. The symptoms are a result of overanticoagulation, which results in blood loss through the kidneys and other organs, resulting in a declining hemoglobin/hematocrit (H/H). The decrease of RBCs results in the compensation mechanism for shock by increasing the HR when compensating for the tissue hypoxia present from the lack of RBCs. Decreased perfusion and O 2 saturation in the tissues will be present. #1 is incorrect. Vasovagal symptoms would include decreasing heart rate and not impact the H/H or O 2 saturation levels. Blood pressure may be down and fainting usually occurs with orthostatic positioning. #2 is incorrect. Ischemia may cause BP and HR symptoms with changes in O 2 sats but not the decline in H/H. #3 is incorrect. Emboli distal to the insertion site will not alter the BP, HR, H/H, or O 2 sats. The pulses will be diminished or absent depending on the degree of obstruction or the size of thrombi.
The ECG of a patient receiving tPA for a myocardial infarction shows that the ST segment has returned to baseline. How should the nurse interpret this finding? A) The myocardial injury is evolving. B) The blocked artery has been reperfused. C) The patient has become more relaxed. D) The spasm in the coronary artery has resolved.
B. Early reperfusion can resolve coronary ischemia.
An essential aspect of teaching that may prevent recurrence of heart failure is: a. notifying the physician if a 2-lb weight gain occurs in 24 hours. b. compliance with diuretic therapy. c. taking nitroglycerin if chest pain occurs. d. assessment of an apical pulse.
B Reduction or cessation of diuretics usually results in sodium and water retention, which may precipitate heart failure.
A patient is admitted to the emergency department with clinical indications of an acute myocardial infarction. Symptoms began 3 hours ago. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient? a. Administer thrombolytic therapy unless contraindicated b. Diurese aggressively and monitor daily weight c. Keep oxygen saturation levels at least 88% d. Maintain heart rate above 100 beats/min
A Medical treatment of AMI is aimed at relieving pain, providing adequate oxygenation to the myocardium, preventing platelet aggregation, and restoring blood flow to the myocardium through thrombolytic therapy or acute interventional therapy such as angioplasty. Since interventional cardiology is not available, thrombolytic therapy is indicated. Oxygen saturation should be maintained at higher levels to ensure adequate oxygenation to the heart muscle. An elevated heart rate increases oxygen demands and should be avoided. Diuresis is not indicated with this scenario.
The multidisciplinary team would identify which of the following goals for initial collaborative management of a patient with an acute coronary event (ACS)? (Select all that apply.) A) Maximize coronary artery blood flow. B) Limit the size of infarction by decreasing oxygen demands. C) Strengthen the heart by increasing activity as soon as possible. D) Balance oxygen demand with supply. E) Prevent dysrhythmias with prophylactic antidysrhythmic medications.
A, B, D The symptoms are caused by decreased oxygen or increased demand for oxygen in the myocardium. If the nurse increases the oxygen supply and decreases the level of activity (decreasing metabolic rates) to decrease the demands, ischemic tissue can recover or limit additional tissue death. Prolonged continually, hypoxia will eventually cause tissue necrosis (death). #3 and #4 are incorrect. Ambulation will increase demand for O 2 and is not recommended until the patient is stable. Preventing dysrhythmias prophylactically is not appropriate because the nurse may not know which type of irregularity will occur until it does occur. Early treatment should be used once the irregularity has been identified but it is not recommended to give medications before symptoms have developed. Dysrhythmias occur due to hypoxia, electrolyte imbalance, necrosis, or fluid shifts in the myocardium once the vessel has ruptured or occluded in ACS.
Which statements are true regarding the symptoms of an AMI? (Select all that apply.) a. Dysrhythmias are common occurrences. b. Men have more atypical symptoms than women. c. Midsternal chest pain is a common presenting symptom. d. Some patients are asymptomatic.
A, C, D Chest pain is a common presenting symptom in AMI. Dysrhythmias are commonly seen in AMI. Some individuals may have ischemic episodes without knowing it, thereby having a "silent" infarction. Women are more likely to have atypical signs and symptoms, such as shortness of breath, nausea and vomiting, and back or jaw pain.
A nurse is caring for a patient who has just started to bleed from her insertion site following a cardiac catheterization. What should be the nurses first response? The nurse should: A) Apply manual pressure to the site. B) Locate and apply a compression clamp. C) Apply a collagen patch or sheath. D) Administer vitamin K (AquaMEPHYTON).
A. The question is asking what action should be performed first. Vitamin K is an antidote for warfarin. It increases hepatic biosynthesis of blood-clotting factors. But it is not a treatment for an active bleed. If heparin is the source of the bleed, the antidote is protamine sulfate. #2 and #3 are incorrect responses. They might be performed later.
Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink? a. Barium swallow b. Transesophageal echocardiogram c. MUGA scan d. Stress test
B In transesophageal echocardiography, an ultrasound probe is fitted on the end of a flexible gastroscope, which is inserted into the posterior pharynx and advanced into the esophagus. After the procedure, the patient is unable to eat until the gag reflex returns.
A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patient's quality of life? a. Intraaortic balloon pump (IABP) b. Left ventricular assist device (LVAD) c. Nothing, because the patient is in terminal heart failure d. Nothing additional; medical management is the only option
B LVADs are capable of partial to complete circulatory support for short- to long-term use. At present, the LVAD is therapy for patients with terminal heart failure. It would provide better management than medical therapy alone. The IABP is for short-term management of acute heart failure.
Which of the following is appropriate in collaborative management of a patients pulmonary status following coronary artery bypass graft surgery? A) Keeping the patient intubated for at least 48 hours to maximize gas exchange B) Mobilizing the patient as soon as possible to prevent atelectasis and venous stasis C) Evaluating readiness for extubation based on guidelines: PO 2 less than 80 mm Hg with an FiO 2 greater than 40% and a PCO 2 greater than 45 D) Extubating when the patient is arousible to noxious stimuli and shows increased effort for spontaneous breathing
B. Pulmonary functions decline with immobility. Gravitational pull on secretions to posterior areas and inadequate inflation cause atelectasis. Activity and position changes will increase mobility of secretions. Even if the patient is intubated, extra movement by changing of positions will minimize respiratory complications or congestion in the lungs, both of which will increase the work effort of the heart and decrease perfusion and ventilation if not corrected. #1 is incorrect. No set timing is required for extubation readiness is needed. Usually the patient is on the ventilator for less than 24 hours to minimize ventilator-related problems and to maximize O 2 exchange during the first 24 hours after surgery. #3 is incorrect. The goal settings for adequate ventilation are off: O 2 greater than 80 mm Hg, FiO 2 less than 40%, and PCO 2 less than 45. #4 is incorrect. Weaning the patient off the intubation process needs to be done gradually and based on blood gas values, pH, O 2 saturations, respiratory effort, fatigue, and coloring. This will allow for maximum gas exchange with the least O 2 demand when readiness has been achieved. With increased respiratory effort, more O 2 is required due to increased muscle efforts; thus the reasoning for gradually weaning based on each patients response.
The cardiologist has told the patient and family that the diagnosis is hypertrophic cardiomyopathy. Later they ask the nurse what the patient did wrong to cause this condition. The nurse explains: a. "This is a result of a high-cholesterol diet and poor exercise habits." b. "The heart has not been getting enough aerobic exercise and has developed this condition. In cardiac rehabilitation they will work with the patient to strengthen his heart through special exercises." c. "This is an inherited condition. You should give serious consideration to having family members screened for it." d. "This is a result of clot formation in the blood vessels in the heart. We will need to use medications to reduce the risk of further clotting."
C Hypertrophic cardiomyopathy is a genetically inherited disease that affects the myocardial sarcomere.
A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following? a. Complete occlusion of a coronary artery b. Fatty streak within the intima of a coronary artery c. Partial occlusion of a coronary artery with a thrombus d. Vasospasm of a coronary artery
C In unstable angina, some blood continues to flow through the affected coronary artery; however, flow is diminished related to partial occlusion. The pain in unstable angina is more severe, may occur at rest, and requires more frequent nitrate therapy.
Which of the following is an accurate description of the progression of events in an acute coronary syndrome (ACS)? A) A thin fibrin layer stabilizes the ruptured plaque and prevents the occlusion of coronary vessels when stable angina is present in ACS. B) When complete platelet occlusion occurs in a vessel, the ECG changes include nonspecific ST elevation without necrosis occurring in ACS. C) The growth of platelet-rich thrombi in the smaller vessels creates a blockage and is the cause for unstable angina symptoms in ACS. D) Sudden plaque buildup in a narrow vessel immediately leads to an acute myocardial infarction when stable angina is present in ACS.
C. Unstable angina occurs when a blockage from platelet-rich thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest. Eventually, the patient will limit activity to minimize the symptoms. #1 is incorrect. The formation of fibrin along the area of ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel. Therefore, with full occlusion an STEMI occurs. #2 is incorrect. When occlusion occurs, ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output. #4 is incorrect. The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size and other vessels may compensate for this minor hypoxia until the vessel is completely occluded.
Which of the following explanations of the relationship of being overweight to (ACS) should the nurse include when presenting a healthy heart program to a community group? A) Excessive weight will result in a decrease in low-density lipoproteins (LDL) that is linked to ACS. B) Extra weight can lead to diabetes insipidus that will increase the risk for ACS. C) Losing as little as 5% of ones body weight will significantly lower the risk for ACS. D) Obesity, a BMI of greater than 30, increases the risk for ACS at a greater rate than just being overweight.
D. #3 is incorrect information that needs additional teaching or clarification. A 10% loss, not a 5% loss, has been shown to improve risk for ACS. #1 and #2 are incorrect responses for this question because they are correct statements. Increased weight increases the risk for diabetes mellitus and decreased HDL, which are both risk factors for ACS.
