Heart Problem Quizzes

*True/ False* A heart attack is caused by a bunch of fat that clogs the coronary arteries.

False Right. Really a heart attack is caused by clots that catch on the jagged edges of the fatty plaque.

*True/ False* Pain from oxygen deprivation to the heart always shows up as a feeling of an elephant sitting on the chest

False NO, The elephant on the chest feeling is classic. But the pain might also be felt in the left arm or scapula, neck, or even stomach.

*There are 3 major coronary arteries. All other arteries branch off of these 3. The coronary arteries run from the aorta out to the very edges of the heart muscle (myocardium). Coronary circulation occurs when the heart is at rest (diastole). Match the name of the coronary artery with the description.* 1. feeds the left side of the heart 2.feeds the back and bottom of heart 3. feeds the largest part of the heart-the worst artery to have problems with

1. circumflex 2. right coronary 3. left anterior descending

*unstable angina, stable angina, heart attack* 1. The patient continues to complain of chest pain after a third nitroglycerin tablet, and administration of morphine 4mg 2. The EKG tracing shows q waves 3. The chest pain goes away once the patient lies down in bed 4. The chest pain goes away after a second nitroglycerin tablet 5. The patient awakens from solid sleep complaining of chest pain 6. Over time, the chest pain episodes occur more frequently and are more difficult to treat

1. heart attack 2. heart attack 3. stable angina 4. stable angina 5. unstable angina 6. unstable angina

*Some persons are much more likely to develop ACS and MI than others. For each risk factor listed below, select modifiable (meaning that the pt can change the action) or non-modifiable.* 1. high levels of LDL 2. male gender 3. high blood sugars 4. type-A personality 5. age 6. smoking 7. African American 8. sedentary lifestyle 9. overweight

1. modifiable 2. non-modifiable 3. modifiable 4. modifiable 5. non-modifiable 6. modifiable 7. non-modifiable 8. modifiable 9. modifiable

There are many tell-tale diagnostic tests to show that an MI is in progress and that immediate intervention is crucial. Select the diagnostic tests from the list below that would let you know that the patient is having a heart attack (note: MI and heart attack are used interchangably)

- EKG change-ST segment elevation - Elevated CK-MB and Troponin levels - Cardiac catheterization that shows blockage in coronary arteries from clotting, patient reports that chest pain continues even with rest and medications. - Patient is pale, diaphoretic, and nauseated

Healthcare providers must recognize the signs and symptoms of a heart attack and intervene promptly to prevent myocardial tissue death. The goal of treatment is to quickly restore blood flow throughout the heart muscle.

- Percutaneous transluminal coronary angioplasty - Coronary Artery Bypass Graft

Name the signs and symptoms of cardiac ischemia (lack of oxygen to heart muscle).

- chest pain - confusion - dypnea - an abnormal ECG - anxiety

Select some common reasons for clots to develop in the coronary arteries

- endothelial inflammation - - high levels of LDLs - diabetes, valve disorders

There are several ways that oxygen demand can be decreased and oxygen perfusion can be increased. Select these from the list below.

- give morphine - give oxygen - give aspirin as ordered - give nitroglycerin

What are some of the signs and symptoms of a heart attack?

- pain in left scapula - nausea - pallor - diaphoresis - confusion

Thrombolytics can be an effective way to bust up the blockage and restore blood flow. Thrombolytics are not for everyone!

- pregnancy - recent surgery - head trauma - Chest pain that began 2 days ago

* Nitroglycerin, aspirin, ACE inhibitor, beta blocker, calcium channel blocker, morphine* 1. leads to some vasodilation and diuresis thereby decreasing preload and afterload 2. longer acting vasodilator working by inhibiting calcium action 3. decreases platelet stickiness thereby preventing obstructive clots from worsening 4. causes overall relaxation of vessels (and everything else) thereby decreasing preload and afterload 5. provides immediate coronary artery dilation to increase blood flow 6. slows heart rate and decreases contractility, thereby allowing more coronary circulation

1. ACE inhibitor 2. calcium channel blocker 3. aspirin 4. morphine 5. Nitroglycerin 6. beta blocker

*Match the signs of a heart attack with their descriptions. (CK-MB and Troponin, abnormal ECG, Tachycardia)* 1. Enzymes will go up in response to myocardial cell death. 2. You will typically see an ST segment change when the heart is deprived of oxygen. 3. The heart will beat faster due to sympathetic response.

1. CK-MB 2. abnormal ECG 3. Tachycardia

Match the words with the definitions. *cardiac output, stroke volume, preload, afterload and ejection fraction* 1. the resistance that the heart has to pump against-it will be higher for a patient with tight arteries 2. the volume that is pumped with each heartbeat 3. stroke volume x heart rate 4. percentage that is ejected with each heart beat. (about 55-85% in the normal adult). A low value here means that the heart has poor contractility. The value would be low for the patient with heart failure 5. the stretch that occurs at the end of diastole-determined by fluid that returns to the atria

1. afterload 2. stroke volume 3. cardiac output 4. ejection fraction 5. preload

1. Decreases sympathetic nervous system activity thereby reducing preload (translation: calms down flight or fight response, dilating veins that carry blood back to heart) 2. If given within 6 hours after the onset of heart attack, these drugs will prevent damage to the heart muscle by dissolving clots 3. Prevent recurrence of a clot after its been busted 4. Oppose coronary artery tightening, decrease preload and afterload 5. Decrease contractility and rate of heart thereby decreasing oxygen demand 6. Inhibit platelet activators therby making platelets less sticky and less able to stick to other clots

1. analgesics (like morphine) 2. thrombolytics (like TPA) 3. anticoagulant (like heparin) 4. vasodilator (like nitroglyceerin) 5. beta-blocker (like metroprolol) 6. antiplatelet agents (like aspirin)

In counseling the patient about sexual activity following an MI , what should the nurse do? Select one: A. Discuss sexual activity while teaching about other physical activity B. Inform the patient that impotence is a common long-term complication following MI C. Have the patient ask the health care provider when sexual activity can be resumed D. Wait for the patient to ask about resuming sexual activity

A. Discuss sexual activity while teaching about other physical activity - Resumption of sexual activity is often difficult for patients to approach and it is reported that most cardiac patients do not resume sexual activity after MI. The nurse can give the patient permission to discuss concerns about sexual activity by introducing it as a physical activity when other physical activities are discussed. Health care providers may have preferences regarding the timing of resumption of sexual activity and the nurse should discuss this with the health care provider and the patient but addressing the patient's concerns is a nursing responsibility. Patients should be informed that impotence after MI is common but that it usually disappears after several attempts.

What accurately describes the pathophysiology of CAD? A. Endothelial alteration may be caused by chemical irritants such as hyperlipidemia or by tobacco use B. Collateral circulation in the coronary circulation is more likely to be present in the young patient with CAD C. Partial or total occlusion of the coronary artery occurs during the stage of raised fibrous plaque Incorrect D. The leading theory of atherogenesis proposes that infection and fatty dietary intake are the basic underlying causes of atherosclerosis

A. Endothelial alteration may be caused by chemical irritants such as hyperlipidemia or by tobacco use

A second 12-lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST segment elevation. What does the nurse recognize that this finding indicates? Select one: A. MI associated with prolonged and complete coronary thrombosis B. Lack of permanent damage to myocardial cells C. MI associated with transient or incomplete coronary artery occlusion D. Transient ischemia typical of unstable angina

A. Mi associated with prolonged and complete coronary thrombosis - A differentiation is made between MIs that have ST segment elevations on ECG and those that do not because chest pain accompanied by ST segment elevations is associated with prolonged and complete coronary thrombosis and is treated with reperfusion therapy.

Which characteristics describe unstable angina (select all that apply)? Select one or more: A. Usually precipitated by exertion B. Unpredictable and unrelieved by rest C. Characterized by progressive severity D. Occurs only when the person is recumbent E. Usually occurs in response to coronary artery spasm Incorrect

B, C

Which effects contribute to making nitrates the first-line therapy for the treatment of angina? (select all that apply) A. Decrease heart rate (HR) B. Decrease preload C. Decrease afterload D. Dilate coronary arteries E. Prevent thrombosis of plaques F. Decrease myocardial contractility

B, C, D Nitrates decrease preload and afterload to decrease the coronary workload and dilate coronary arteries to increase coronary blood supply. The other options are not attributed to nitrates.

Myocardial ischemia occurs as a result of increased oxygen demand and decreased oxygen supply. What factors and disorders result in increased oxygen demand (select all that apply)? Select one or more: A. Hypovolemia or anemia B. Increased cardiac workload with aortic stenosis C. Narrowed coronary arteries from atherosclerosis Incorrect D. Angina in the patient with atherosclerotic coronary arteries E. Left ventricular hypertrophy caused by chronic hypertension F. Sympathetic nervous system stimulation by drugs, emotions, or exertion

B, D, E, F Increased oxygen demand is caused by increasing the workload of the heart, including left ventricular hypertrophy with hypertension, sympathetic nervous stimulation, and anything precipitating angina. Hypovolemia, anemia, and narrowed coronary arteries contribute to decreased oxygen supply.

In the patient with chest pain, which results can differentiate unstable angina from an MI? A. ECG changes present at the onset of the pain B. Creatine kinase (CK)-MB enzyme elevations that peak 18 hours after the infarct C. A chest x-ray indicating left ventricular hypertrophy D. Appearance of troponin in the blood 48 hours after the infarct

B. Creatinine kinase (CK)- MB enzyme elevations that peak 18 hours after the infarct - Creatine kinase-muscle and brain subunits band (CK- MB) is a tissue enzyme that is specific to cardiac muscle and is released into the blood when myocardial cells die. CK-MB levels begin to rise about 6 hours after an acute MI, peak in about 18 hours, and return to normal within 24 to 36 hours. This increase can identify the presence of and quantify myocardiac damage. Cardiac troponin T and troponin I are released with myocardial damage, rise as quickly as CK-MB does, and remain elevated for 2 weeks. ECG changes are often not apparent immediately after infarct and may be normal when the patient seeks medical attention. An enlarged heart, determined by x-ray, indicates cardiac stress but is not diagnostic of acute MI.

What types of angina can occur in the absence of CAD (select all that apply)? Select one or more: A. Nocturnal angina B. Silent ischemia Incorrect C. Prinzmetal's angina D. Microvascular angina E. Chronic stable angina Incorrect

C, D

What are manifestations of acute coronary syndrome (ACS) (select all that apply)? Select one or more: A. Dysrhythmia B. Stable angina C. Unstable angina D. ST-segment-elevation myocardial infarction (STEMI) E. Non-ST-segment-elevation myocardial infarction (NSTEMI)

C, D, E Unstable angina, ST-segment-elevation myocardial infarction (STEMI), and non-ST-segment-elevation myocardial infarction (NSTEMI) are conditions that are manifestations of acute coronary syndrome (ACS). The other options are not manifestations of ACS

The nurse suspects stable angina rather than MI pain in the patient who reports that his chest pain? A. does not radiate to the neck, back, or arms. B. is a sensation of tightness or squeezing. C. is precipitated by physical or emotional exertion. D. is relieved by nitroglycerin.

D. is relieved by nitroglycerin - One of the primary differences between the pain of angina and the pain of an MI is that angina pain is usually relieved by rest or nitroglycerin, which reduces the oxygen demand of the heart, whereas MI pain is not. Both angina and MI pain can cause a pressure or squeezing sensation; may or may not radiate to the neck, back, arms, fingers, and jaw; and may be precipitated by exertion.

While obtaining patient histories, which patient does the nurse identify as having the highest risk for CAD? Select one: A. An obese African American man, age 65, with a cholesterol level of 195 mg/dL and a BP of 128/76 mm Hg Incorrect B. A white man, age 54, who is a smoker and has a stressful lifestyle C. A white woman, age 68, with a BP of 172/100 mm Hg and who is physically inactive D. An Asian woman, age 45, with a cholesterol level of 240 mg/dL and a BP of 130/74 mm Hg

C. A white woman, age 68, with a BP of 172/100 mm Hg and who is physically inactive - This white woman has one unmodifiable risk factor (age) and two major modifiable risk factors (hypertension and physical inactivity). Her gender risk is as high as a man's because she is over 65 years of age. The white man has one unmodifiable risk factor (gender), one major modifiable risk factor (smoking), and one minor modifiable risk factor (stressful lifestyle). The Asian woman has only one major modifiable risk factor (hyperlipidemia) and Asians in the United States have fewer myocardial infarctions (MIs) than do whites. The African American man has an unmodifiable risk factor related to age and one major modifiable risk factor (obesity).

When caring for a patient after a cardiac catheterization with coronary angiography, which finding would be of most concern to the nurse? a. swelling at the catheter insertion site b. patient pain at the insertion site as 4 on a scale of 0 to 10 c. Absence of pulses distal to the catheter insertion site d. development of raised wheals on the patient"s trunk

C. Absence of pulses distal to the catheter insertion site - An absence of pulses distal to the catheter insertion site indicates that clotting is occluding blood flow to the extremity and is an emergency that requires immediate medical attention. Some swelling and pain at the site are expected but the site is also monitored for bleeding and a pressure dressing and perhaps a sandbag or clamp may be applied. Hives may occur as a result of iodine sensitivity and will require treatment but the priority is the lack of pulses.

When the patient who is diagnosed with an MI is not relieved of chest pain with IV nitroglycerin, which medication will the nurse expect to be used? A. Angiotensin-converting enzyme (ACE) inhibitors B. Calcium channel blockers C. IV morphine sulfate D. IV amiodarone (Cordarone)

C. IV morphine sulfate - Morphine sulfate decreases anxiety and cardiac workload as a vasodilator and reduces preload and myocardial O2 consumption, which relieves chest pain. Calcium channel blockers, amiodarone, and ACE inhibitors will not relieve chest pain related to an MI.

A patient is scheduled to have CABAG surgery. What does the nurse explain to him that is involved with the procedure? A. Reversed segments of a saphenous artery from the aorta will be anastomosed to the coronary artery distal to an obstruction B. A synthetic graft will be used as a tube for blood flow from the aorta to a coronary artery distal to an obstruction. C. The internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis. D. A stenosed coronary artery will be resected and a synthetic arterial tube graft will be inserted to replace the diseased artery.

C. The internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis.

Tachycardia that is response of the sympathetic nervous system to the pain of ischemia is detrimental because it increases oxygen demand and... A. increases cardiac output B. causes reflex hypotension C. impairs perfusion of the coronary arteries D. may lead to atrial dysrhythmias

C. impairs perfusion of the coronary arteries. - An increased heart rate (HR) decreases the time the heart spends in diastole, which is the time of greatest coronary blood flow. Unlike other arteries, coronary arteries are perfused when the myocardium relaxes and blood backflows from the aorta into the sinuses of Valsalva, which have openings to the right and left coronary arteries. Thus the heart has a decreased oxygen supply at a time when there is an increased oxygen demand. Tachycardia may also lead to ventricular dysrhythmia

What is the most classic clinical manifestation for a heart attack?

Chest pain

When a patient reports chest pain, why must unstable angina be identified and rapidly treated? A. The pain may be severe and disabling. B. Spasm of a major coronary artery may cause total occlusion of the vessel with progression to MI C. ECG changes and dysrhythmias may occur during an attack. D. Atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen.

D. Atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen. - Unstable angina is associated with the rupture of a once-stable atherosclerotic plaque, exposing the intima to blood and stimulating platelet aggregation and local vasoconstriction with thrombus formation. Patients with unstable angina require immediate hospitalization and monitoring because the lesion is at increased risk of complete thrombosis of the lumen with progression to MI. Any type of angina may be associated with severe pain, ECG changes, and dysrhythmias. Prinzmetal's angina is characterized by coronary artery spasm.

The patient has used sublingual nitroglycerin and various long-acting nitrates but now has an ejection fraction of 38% and is considered at a high risk for a cardiac event. Which medication would first be added for vasodilation and to reduce ventricular remodeling? a. Clopidogrel (Plavix) b. Diltiazem (Cardizem) c. Metoprolol (Lopressor) d. Captopril (Capoten)

D. Captopril (Capoten) - It is an angiotensin- converting enzyme (ACE) inhibitor that vasodilates and decreases endothelial dysfunction and may prevent ventricular remodeling. Clopidogrel (Plavix) is an antiplatelet agent used as an alternative for a patient unable to use aspirin. Diltiazem (Cardizem), a calcium channel blocker, may be used to decrease vasospasm but is not known to prevent ventricular remodeling. Metoprolol (Lopressor) is a β-adrenergic blocker that inhibits sympathetic nervous stimulation of the heart.

A patient admitted to the hospital for evaluation of chest pain has no abnormal serum cardiac makers 4 hours after the onset of pain. What noninvasive diagnostic test can be used to differentiate angina form other types of chest pain? A. Transesophageal echocardiogram B. 12-lead ECG C. Coronary angiogram D. Exercise stress test

D. Exercise stress test - An exercise stress test will reveal ECG changes that indicate impaired coronary circulation when the oxygen demand of the heart is increased. A single ECG is not conclusive for CAD and negative findings do not rule out CAD. Coronary angiography can detect narrowing of coronary arteries but is an invasive procedure. Echocardiograms of various types may identify abnormalities of myocardial wall motion under stress but are indirect measures of CAD.

What causes the pain that occurs with myocardial ischemia?

Lactic acid accumulation during anaerobic metabolism

*True/ False* The most common problem occurring from an MI is a ventricular dysrythmia. This problem occurs because cells in the nerve conduction pathway are destroyed.

True

*True/ False* The most severe form of heart failure is cardiogenic shock. This complication occurs when so much heart muscle tissue is damaged that the heart loses its ability to pump enough blood out to meet metabolic demands.

True

*True/ False* The very best thing that health providers can do for a patient with chest pain is to decrease oxygen demand and improve perfusion.

True

What is the leading cause of death in the United States? a. diabetes mellitus b. cerebrovascular accident c. coronary artery disease d. Cancer e. Chronic obstructive pulmonary disease

c. Coronary artery disease - is the leading cause of death in the United States

a 52- year-old man is admitted to the emergency department with severe chest pain. On what basis would the nurse suspect an MI? Select one: a. He says he is anxious and has a feeling of impending doom. b. He reports nausea and vomited once at home. c. He reports he has had no relief of the pain with rest or position change. d. He has pale, cool, clammy skin.

c. He reports he has had no relief of the pain with rest or position change. - The subjective report of the pain from an MI is usually severe. It usually is unrelieved by nitroglycerin, rest, or position change and usually lasts more than the 15 or 20 minutes typical of angina pain. All of the other symptoms may occur with angina as well as with an MI.