medsurg chapter 20 EAQ
A patient asks the LPN/LVN, "What does myocardial infarction mean?" Which response by the nurse is most accurate?
"A myocardial infarction means that damage or necrosis of an area in the heart muscle has occurred."
A patient with angina has been given instructions concerning his care. Which of these statements, if made by the patient, indicates a need for further instruction? 1 "If my mouth is dry, and I need nitroglycerine, I should sip water first." 2 "I'll try not to go out-of-doors when the weather is extremely chilly." 3 "I should swallow 3 nitroglycerin pills, 5 minutes apart, if I have chest pain." 4 "I'm planning to take a nitroglycerin pill before I do activities that have caused me to have chest pain in the past."
"I should swallow 3 nitroglycerin pills, 5 minutes apart, if I have chest pain." Nitroglycerine tablets should be taken sublingually, not swallowed. Wetting the mouth before taking nitroglycerine, avoiding extreme temperatures, and easy access to nitroglycerin are appropriate statements.
A patient has stable angina. During the history taking, which information will the nurse typically expect to hear from the patient? "My chest pain occurs at rest." "My chest pain is unpredictable." "My chest pain occurs with activity or stress." "My chest pain can last for several hours at a time."
"My chest pain occurs with activity or stress." Usually, stable angina lasts only a few minutes and is relieved by rest or with nitroglycerine. Stable angina (also called exertional angina) occurs most often with exercise or activity and stress, but usually subsides with rest. Stable angina occurs intermittently and is often predictable. Unstable angina and variant angina can occur at rest and are unpredictable.
The nurse is monitoring the elevated CK-MB level of a patient who has experienced a myocardial infarction (MI). When does the nurse anticipate the CK-MB level will return to normal?
72 to 88 hours During an MI, the level of CK-MB rises within 2 to 6 hours of the MI, peaks within 12 to 24 hours, and returns to normal within 3 days after the MI.
Which patient teaching points would be most appropriate to include when educating a patient with coronary artery disease? A high-fat diet A low-fat diet, weight control, and exercise. Maintaining weight a high sodium diet
A low-fat diet, weight control, and exercise. The teaching points most appropriate for a patient with coronary artery disease are a low-fat diet, weight control, exercise prescribed to lower cholesterol and total lipids. A high-fat diet, a low or high sodium diet would increase the patient's risk of coronary artery disease and heart disease. Maintaining weight or gaining weight would increase risks for coronary artery disease.
The student nurse is observing in the ED (emergency department) and notices the nurses using the acronym MONA when caring for a patient with a suspected acute MI. The student is correct when identifying the "A" as referring to which intervention? 1 Obtaining ABGs 2 Administration of aspirin 3 Assessing for degree of chest pain 4 Asking the patient if he has a history of cardiac problems
Administration of aspirin In 2004 the American College of Cardiology suggested the initiation of the MONA (morphine, oxygen, nitrates, and aspirin) regimen when a patient presented in the ED with an acute MI. The goal of MONA is to relieve pain, decrease ischemia, and prevent further circulatory collapse and shock in the MI patient.
A patient has a diagnosis of stable angina. Which drug is most often used to relieve this type of angina pain? 1 Morphine 2 Nitroglycerin (NTG) 3 Aspirin with codeine 4 Meperidine hydrochloride (Demerol)
Administration of morphine Pain control is a high priority for the patient experiencing an acute MI. Morphine is the drug of choice because of its vasodilation property. Proper positioning and administration of codeine or beta blockers are not the most appropriate interventions.
A patient has been admitted to the coronary care unit with a diagnosis of acute myocardial infarction. The patient is experiencing severe chest pain. What intervention is most likely to relieve the patient's pain? 1 Proper positioning 2 Administration of codeine 3 Administration of morphine 4 Administration of beta blockers
Administration of morphine Pain control is a high priority for the patient experiencing an acute MI. Morphine is the drug of choice because of its vasodilation property. Proper positioning and administration of codeine or beta blockers are not the most appropriate interventions.
The incidence of coronary artery disease is disproportionately higher among individuals of which ethnicity? 1 Caucasian 2 Asian American 3 African American 4 Hispanic American
African American The incidence of coronary artery disease is disproportionately higher among African Americans. Caucasians, Asian Americans, and Hispanic Americans report incidences of coronary artery disease, but not to the extent of African Americans.
A member of which group would be most likely to develop coronary artery disease?
African American men
A patient is seen in the cardiology office and has been diagnosed with coronary artery disease. The nurse who is teaching this patient would include information about which factors that make a person more susceptible to this disease process? Select all that apply. 1. Age of more than 40 2 African American race 3 Use of oral contraceptives 4 Decreased cholesterol levels 5 Male gender; female gender after menopause
Age of more than 40 African American race Use of oral contraceptives Male gender; female gender after menopause Age, gender, race, and the use of oral contraceptives make a person more susceptible to coronary artery disease. Increased cholesterol levels make the patient more susceptible to coronary artery disease.
Which are true statements regarding angina pectoris? Select all that apply. 1Angina occurs only at rest. 2Angina may appear as jaw pain. 3Angina should be relieved by nitroglycerin. 4Angina may resemble heartburn or indigestion. 5Angina indicates a lack of oxygen and blood supply to the heart.
Angina may appear as jaw pain. Angina should be relieved by nitroglycerin. Angina may resemble heartburn or indigestion. Angina indicates a lack of oxygen and blood supply to the heart. Angina indicates a lack of oxygen and blood supply to the coronary arteries, usually as a result of a narrowing of the lumen. When the myocardial oxygen demand exceeds the available supply, ischemia occurs, resulting in chest pain or angina. Angina may resemble heartburn or indigestion in some patients. Patients may not have the "classic" symptom of chest pain, especially older adults and women. Angina is usually relieved by nitroglycerin. This is one way in which angina is differentiated from a myocardial infarction (MI)—pain from the MI is generally not relieved by nitroglycerin. The patient should be instructed to take a nitroglycerin tablet and lie down when experiencing an anginal attack. If the pain is not relieved, the patient may take two more nitroglycerin tablets, 5 minutes apart. If the pain is still unrelieved after the third nitroglycerin tablet, the patient needs to seek emergency medical attention. Although the pain from angina is typically substernal chest pain, it may be present in different ways. It may radiate to the chest, arm, or jaw. Angina may appear as posterior thoracic or jaw pain only. Angina typically occurs with an increased cardiac workload (e.g., exercise, heavy meal, cold, stress) and may disappear at rest and/or with administration of nitroglycerin.
A patient is admitted with an acute myocardial infarction (MI) and is reporting pain at a level of 10 out of 10. Respirations are 28 breaths/min, pulse is 90 beats/min, and blood pressure is 140/90 mm Hg. Which intervention should the nurse implement?
Apply oxygen per nasal cannula Provide supplemental oxygen as ordered through nasal cannula at 2 to 4 L/min to provide adequate oxygen to the heart muscle. As soon as a patient with an acute MI is brought to the emergency department, measures are taken to relieve pain, decrease ischemia, and prevent further circulatory collapse and shock. The morphine, oxygen, nitrates, aspirin (MONA) regimen is initiated. Morphine is usually administered in small amounts (2 to 4 mg) intravenously every few minutes until pain relief is evident. The patient is in pain; a low-fat diet will not be effective against the pain. Lasix is a diuretic, not a pain medication. The head of the bed is usually elevated at least 30 degrees.
What is a major factor in coronary artery disease and a form of arteriosclerosis that involves plaque-containing cholesterol and lipids that form fatty streaks within the arteries? 1 Arteriosclerosis 2 Atherosclerosis 3 Congestive heart failure 4 Coronary artery disease
Atherosclerosis Atherosclerosis is a major factor in coronary artery disease and a form of arteriosclerosis that involves plaque-containing cholesterol and lipids that form fatty streaks within the arteries. Arteriosclerosis is a general term for disorders that cause the thickening or loss of elasticity of the arteries. Congestive heart failure is the exhaustion of the heart muscle and the resultant engorgement of the heart's chambers and the blood vessels. Eventually, sluggish blood flow leads to the retention of fluid and edema in the lungs and elsewhere in the body. Coronary artery disease is a progressive disease that leads to the narrowing or occlusion (blockage) of the coronary arteries.
The nurse is reviewing the list of present medications a patient is taking. The patient is transferred to the nursing unit from the cardiac care unit following an acute myocardial infarction (MI). Which class of drugs is used for decreasing workload on the heart? 1 Antiplatelet agents 2 Lipid-lowering agents 3 Cardiac glycoside agents 4 Beta-adrenergic blockers
Beta-adrenergic blockers Beta-adrenergic blockers are used to decrease workload on the heart by decreasing heart rate and cardiac output. Antiplatelet agents prolong bleeding times and are used to prevent clots that may cause additional MIs. Lipid-lowering agents are used to decreased low-density lipoprotein (LDL) (bad) cholesterol and increase high-density lipoprotein (HDL) (good) cholesterol. Cardiac glycoside agents slow the heart rate and increase the force of myocardial contractions and cardiac output.
A female patient arrives at the emergency department and is undergoing several tests to determine the cause of her nausea, weakness, and indigestion-like discomfort. What immediate diagnostic labs or tests does the nurse expect to use to determine or rule out the cause of her symptoms? Select all that apply. 1CPK 2ECG 3EMG 4SGOT 5Troponin I
CPK ECG Troponin I The tests used to determine the cause of the patient's nausea, weakness, and indigestion-like discomfort will focus on ruling out myocardial infarction (MI), because these symptoms are common among women who are experiencing an MI. CPK, ECG, and Troponin I will be among the tests used to determine or rule out an MI. An EMG is a musculoskeletal test and an SGOT is a liver function test; neither of these would be used to initially rule out an MI.
What disease process is described as a progressive disease that leads to the narrowing or occlusion (blockage) of the coronary arteries?
Coronary artery disease Coronary artery disease is a progressive disease that leads to the narrowing or occlusion (blockage) of the coronary arteries. Arteriosclerosis is a general term for disorders that cause the thickening or loss of elasticity of the arteries. Atherosclerosis is a major factor in coronary artery disease, and it is a form of arteriosclerosis that involves plaque-containing cholesterol and lipids that form fatty streaks within the arteries. Congestive heart failure is the exhaustion of the heart muscle and the resultant engorgement of the heart's chambers and the blood vessels. Eventually, sluggish blood flow leads to the retention of fluid and edema in the lungs and elsewhere in the body.
When teaching a patient about modifying risks related to atherosclerosis, what action should the nurse teach to help lower the risk of coronary artery disease? 1 Increase low-density lipoprotein levels using medications 2 Increase low-density lipoprotein levels using diet and exercise 3 Decrease low-density lipoprotein levels using diet and exercise 4 Decrease low-density lipoprotein levels using an aspirin regimen
Decrease low-density lipoprotein levels using diet and exercise Low-density lipoproteins contain more cholesterol than any other lipoprotein and have an attraction to arterial walls, whereas high-density lipoproteins carry lipids away from the arteries to the liver for metabolism and prevent lipid accumulation within the arterial walls. Decreasing low-density lipoprotein levels is most helpful in lowering the patient's risk of coronary artery disease. Patients can do this using diet and exercise. An aspirin regimen is used to prevent blood clots that may cause a myocardial infarction (MI)
A patient has recently received tissue plasminogen activator (t-PA) to treat a myocardial infarction (MI). What is the primary purpose of this drug? 1 Dissolves existing clots 2 Inhibits platelet aggregation 3 Prevents future clots from forming 4 Dilates peripheral and coronary arteries
Dissolves existing clots The primary purpose of t-PA is to dissolve existing clots. T-PA is classified as a thrombolytic agent. Aspirin is a drug that inhibits platelet aggregation. A drug that prevents future clots from forming is classified as an anticoagulant, such as warfarin or heparin.
A physician comments that a patient is experiencing the "classic" signs and symptoms of a myocardial infarction (MI). What are the immediate "classic" signs and symptoms of MI? Select all that apply.
Dyspnea Diaphoresis Abrupt and severe chest pain
What signs and symptoms make the nurse concerned that the recovering patient with myocardial infarction is developing the complication of heart failure? 1 Murmur, dyspnea, and decreased cardiac output 2 Dyspnea, crackles in the lungs, and jugular venous distention 3 Friction rub on auscultation and chest pain that worsens with movement 4 Irregular pulse, heart rate of less than 120 or greater than 40 bpm, and more than three premature ventricular contractions
Dyspnea, crackles in the lungs, and jugular venous distention The complication of heart failure involves symptoms of dyspnea, crackles in the lungs, and jugular venous distention. Murmur, dyspnea, and decreased cardiac output are associated with papillary muscle dysfunction. Dysrhythmia is associated with irregular pulse, a heart rate of greater than 120 or less than 40 bpm, and more than three premature ventricular contractions. Friction rub on auscultation and chest pain that worsens with movement are associated with pericarditis.
The nurse is caring for a patient who was just admitted to the hospital with an acute myocardial infarction (MI). What complication is the nurse most concerned will occur with this patient? 1 Dysrhythmia 2 Hyperkalemia 3 Respiratory failure 4 Hypovolemic shock
Dysrhythmia The most common complication following an MI is dysrhythmia due to increased myocardial irritability, which can be fatal. The patient would develop cardiogenic, not hypovolemic, shock. Hyperkalemia and respiratory failure are not the nurse's greatest concerns at this time.
A patient with a 10-year history of angina is admitted to the unit with chest pain. The working medical diagnosis is to rule out myocardial infarction. Definitive diagnosis of MI will be based on which information? Select all that apply. 1Electrocardiogram 2 Cardiac enzyme levels 3 Fluid and electrolyte status t4 Patient history and physical exam 5 CBC (complete blood count) with differential and ABGs (arterial blood gases)
Electrocardiogram Cardiac enzyme levels Patient history and physical exam
In addition to nutrition, which aspect is an important part of an effective weight loss plan? 1 Sleep 2 Exercise 3 Reading 4 Surgical intervention
Exercise Nutrition and exercise go hand in hand. It is difficult to maintain or lose weight without engaging in some form of exercise. Sleep is an important part of overall health but will not achieve weight loss. Reading will not cause weight loss. Surgical intervention is not the first step in weight loss.Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
Which individual would be the most likely candidate for CABG surgery? 1 Male, age 25, with severe cardiomyopathy 2 Male, age 85, with chronic heart failure (HF) 3 Female, age 62, with malignant hypertension 4 Female, age 48, with chronic angina and coronary artery disease (CAD)
Female, age 48, with chronic angina and coronary artery disease (CAD) The patient with chronic angina and coronary artery disease would be the most likely candidate for CABG. The patients with HF and malignant hypertension would most likely be treated with medications and diet; the patient with myopathy may be a candidate for a heart transplant.
What signs and symptoms make the nurse concerned that the recovering patient with myocardial infarction is developing the complication of pericarditis? Murmur, dyspnea, and decreased cardiac output 2 Dyspnea, crackles in the lungs, and jugular venous distention 3 Friction rub on auscultation and chest pain that worsens with movement 4 Irregular pulse, heart rate of less than 120 or greater than 40 bpm, and more than three premature ventricular contractions
Friction rub on auscultation and chest pain that worsens with movement The complication of pericarditis has symptoms that include pericardial friction rub on auscultation and chest pain that worsens with movement. Heart failure involves symptoms of dyspnea, crackles in the lungs, and jugular venous distention. Murmur, dyspnea, and decreased cardiac output are associated with papillary muscle dysfunction. Dysrhythmia is associated with irregular pulse, a heart rate of greater than 120 or
A patient has been transferred to the nursing unit following an acute myocardial infarction (MI). For which complications of an acute MI should the nurse monitor? Select all that apply. 1Heart failure 2Dysrhythmias 3Pulmonary edema 4Infective endocarditis 5Papillary muscle rupture
Heart failure Dysrhythmias Pulmonary edema Papillary muscle rupture When myocardial tissue dies as a result of acute MI, the pumping action of the heart muscle is affected in that area and the conduction of impulses is also affected. Heart failure, dysrhythmias, pulmonary edema, and papillary muscle rupture (resulting in valve replacement) may result. Infective endocarditis is a microbial infection of the endocardium, primarily the heart valves. It is not a complication of myocardial infarction
What are some treatment options for coronary artery disease? Select all that apply.
Heart transplant Coronary artery bypass graft surgery Transmyocardial laser revascularization Percutaneous transluminal coronary angioplasty
What important patient teaching information should be given with sublingual nitroglycerin tablets for a patient who is at home? Select all that apply. 1 Take this drug with a full glass of water. 2 If possible, the patient should lie down when using the medication. 3 The apical heart rate should be checked before giving the medication. 4 Keep this medicine in a cool, dark place. It should be carried with the patient at all times. 5 If it has been 5 minutes since the first pill was taken and the pain has not been relieved, go to the emergency department.
If possible, the patient should lie down when using the medication. Keep this medicine in a cool, dark place. It should be carried with the patient at all times. If it has been 5 minutes since the first pill was taken and the pain has not been relieved, go to the emergency department. The important teaching that should be done regarding sublingual nitroglycerin tablets includes keeping the medicine in a cool, dark place and carrying it at all times. If possible, the patient taking sublingual nitroglycerin should lie down. Sublingual medications are placed under the tongue, not taken by mouth with a full glass of water. The apical heart rate should not be checked before sublingual nitroglycerin tablets are taken. The blood pressure is mostly affected by this vasodilator medication.
What can precipitate an angina pectoris attack? Select all that apply. Infection 2 Physical exertion 3 Exposure to heat 4 Eating a heavy meal 5 Emotional excitement
Infection Physical exertion Eating a heavy meal Emotional excitement
A patient who is admitted to the coronary care unit with an acute MI is complaining of severe substernal chest pain. What is the cause of the chest pain? Ischemia of the myocardium 2 Ischemia of the carotid artery 3 Spasm of the coronary arteries 4 Vasodilation of the coronary veins
Ischemia of the myocardium
A nurse is caring for a patient with a history of chronic stable angina who complains of chest pain. Which factor is true of ischemia related to angina?
It will be relieved by rest, nitroglycerin, or both. Chronic stable angina is characterized by intermittent chest pain, often described as pressure or tightness that occurs over a period of time in the same pattern, onset, and intensity. It commonly subsides when precipitating factors have stopped and the patient is at rest or with the use of nitroglycerin. The pain usually lasts just 5 to 15 minutes and does not always indicate irreversible myocardial damage. Vomiting and extreme fatigue are symptoms of myocardial infarction and are not commonly seen in chronic stable angina.Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options . Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.
A patient with angina is being discharged and has been prescribed nitroglycerin (NTG) tablets. What instructions should the nurse give this patient regarding the medication? 1 Lie down when using nitroglycerine tablets. 2 It is necessary to refill the supply every 6 months. 3 The tablet should be crushed and taken with water. 4 One NTG tablet should be taken every 15 minutes if pain occurs.
Lie down when using nitroglycerine tablets. The patient should lie down when taking nitroglycerine tablets. The expiration dates on the bottle should be checked frequently, and the tablets should be replaced accordingly. Nitroglycerin should be taken sublingually. If the pain does not subside, the patient should then call for help and be taken to the emergency department. The tablets should be taken sublingually, not crushed or swallowed.
Which term(s) indicate what occurs with cell death of the myocardium? Select all that apply. Necrosis 2 Ischemia 3 Perfusion 4 Infarction 5 Atherosclerosis
Necrosis Infarction Necrosis and infarction occur when cell death of the myocardium occurs. Ischemia is a decrease in blood supply. Perfusion is the act of supplying blood to the heart or other organs through the arteries. Atherosclerosis involves the thickening and loss of elasticity of the arteries.
A patient reports having heavy chest pain behind the sternum, which radiates to the arm and jaw, accompanied by diaphoresis. The health care provider has been notified. The nurse realizes which category of drug will likely be prescribed for immediate relief of these symptoms? 1 Nitroglycerin 2 Cardiac glycoside agents 3 Calcium channel blockers 4 Beta-adrenergic blocker or beta-blocker
Nitroglycerin Nitroglycerin is primarily a vasodilator to be used in the acute phase. Calcium channel blockers act to dilate coronary arteries, decrease oxygen (O 2) consumption, and treat dysrhythmias originating above the ventricles. Beta-adrenergic blockers decrease heart rate, cardiac output, and impulse conduction velocity.
A patient was admitted yesterday after a myocardial infarction (MI). Which statement is true regarding treatment for a patient with MI? 1 Thrombolytic agents must be initiated within 24 hours of the onset of symptoms to be effective. 2 Thrombolytic agents, such as aspirin, are used to minimize infarct size and maximize heart function. 3 Morphine sulfate is contraindicated in a patient with MI because of its effects on the central nervous system. 4 Nursing concerns for a patient who has experienced an acute MI includes minimizing activity and providing for rest.
Nursing concerns for a patient who has experienced an acute MI includes minimizing activity and providing for rest. The treatment for a patient with an acute MI will be directed toward relieving pain and promoting rest. After this period, activities are resumed gradually, depending on the size of the infarct and patient characteristics. A program of cardiac rehabilitation will be designed for the patient and implemented. Thrombolytic agents are used to minimize infarct size and maximize heart function. Aspirin is an antiplatelet medication, not a thrombolytic agent. Thrombolytic agents must be initiated within 3 to 5 hours of the onset of symptoms to be effective, although they are most effective if administered within 30 minutes to 1 hour. Morphine sulfate is useful for the patient with MI because it helps with vasodilation of coronary arteries, relief of pain, and reduction of apprehension. It also decreases myocardial oxygen demands, reduces contractility, and slows the heart rate.
A patient enters the emergency department with chest pain, and it is determined that he is experiencing a myocardial infarction. What are some of the common treatments initiated for this condition? Select all that apply. 1. Oxygen 2 Demerol 3 Ibuprofen 4 Nitrous gas 5 Nitroglycerin
Oxygen Nitroglycerin Morphine (not Demerol), oxygen (not nitrous gas), nitrates/ nitroglycerin, and aspirin (not ibuprofen) are treatments initiated for a person who is experiencing a myocardial infarction.
What is included in the data collection of a patient suffering an acute myocardial infarction (MI)? Select all that apply. Pain 2 Nausea 3 Anxiety 4 Skin color 5 Peripheral vision
Pain Nausea Anxiety Skin color Patients who are suffering an acute MI report chest pain, sometimes with jaw, shoulder, or arm pain. Patients are commonly anxious and fearful as they realize something serious is happening. They are commonly nauseated and frequently have emesis. Their skin color may be pale or cyanotic as a result of impaired oxygenation. Peripheral vision is not affected by an acute (MI).
Coronary revascularization with coronary artery bypass graft (CABG) surgery is recommended for which patients? Select all that apply. 1 Patients with diabetes mellitus 2 Patients with Dressler syndrome 3 Patients with severe aortic stenosis 4 Patients who are not candidates for percutaneous coronary intervention 5 Patients who have failed percutaneous intervention and have recurrent chest pain
Patients with diabetes mellitus Patients who are not candidates for percutaneous coronary intervention Patients who have failed percutaneous intervention and have recurrent chest pain Coronary revascularization with CABG is recommended for patients who are not candidates for percutaneous intervention and who have failed percutaneous intervention and continue to have chest pain, as well as those who are expected to have longer-term benefits with this surgery than with catheterization. Patients with diabetes mellitus have an increased risk for coronary artery disease, and CABG. Severe aortic stenosis is not an indicator for cardiac revascularization surgery. Dressler syndrome is a complication of heart surgery.
A hospitalized patient is 2 days post-myocardial infarction (MI). What possible complications should the nurse monitor the patient for at this stage in recovery? Select all that apply. 1Pericarditis 2Dysrhythmia 3Heart failure (HF) 4Cardiogenic shock 5Dressler syndrome
Pericarditis Dysrhythmia Heart failure (HF) Cardiogenic shock
A patient who has had a myocardial infarction should be monitored for which complications? Select all that apply.
Pericarditis Heart failure Dysrhythmia Dressler syndrome Pericarditis, heart failure, dysrhythmia, and Dressler syndrome are complications associated with myocardial infarction. Cardiogenic shock (not hypovolemic shock) is associated with myocardial infarction.
A patient diagnosed with angina is being discharged. The patient will be taking nitroglycerin at home. What teaching should the nurse reinforce about the nitroglycerin tablets? 1Keep it in a clear bottle 2Place it under the tongue 3Take one every minute for a total of three doses 4Drive yourself to the emergency department if chest pain is not relieved
Place it under the tongue Place the tablet under the tongue when taking nitroglycerin. Keep the tablets in the container in which they are supplied; the drug decomposes on exposure to light and air. Repeat every 5 minutes for a total of three doses; if chest pain is not relieved, have another person drive the patient to the emergency department.
The nurse is caring for a patient who has recently been prescribed clopidogrel and wants more information on this drug. The nurse explains that this drug decreases blood clots by which mechanism? 1Prevents fibrin formation 2Prevents creation of thrombin 3Dissolves clots after they have formed 4Prevents platelets from clumping together
Prevents platelets from clumping together Clopidogrel prevents clots by preventing platelets from sticking together. Tissue plasminogen activator (t-PA) dissolves clots that have already formed. Low-molecular-weight heparin (LMWH) prevents the formation of fibrin and thrombin.
History of hemorrhagic stroke
Reteplase is contraindicated in patients with a history of hemorrhagic strokes. Reteplase can be given within 6 hours (preferably) up to 12 hours. Fibrinolytics are administered intravenously to dissolve the thrombus. This treatment is most effective when initiated early (within 6 hours of onset of symptoms) but may be administered up to 12 hours within onset of symptoms. The patient must meet strict criteria (e.g., no recent surgery or active bleeding, no history of stroke, no bleeding disorders) and provide informed consent before administration of fibrinolytic agents.
The nurse is describing to the patient the progressive development of coronary artery disease (CAD). Place the developmental stages of CAD into their proper order. 1.Streaks of fat develop within the arteries 2.Collagen plaques form and later become fibrous, accumulating in the artery 3.Plaques decrease vessel size 4.Insufficient blood flow occurs
Streaks of fat develop within the arteries Collagen plaques form and later become fibrous, accumulating in the artery Plaques decrease vessel size Insufficient blood flow occurs The development process of CAD includes fatty streaks appearing on the arteries; plaques accumulating and becoming fibrous, causing decreased vessel size; plaques rupturing and causing clotting; and vessels becoming rigid and narrowing, causing decreased blood flow. If the disease progresses far enough, collateral circulation increases, although this is not considered a formal developmental stage of CAD. In CAD, elevated levels of low-density lipoproteins cause the transport of cholesterol and other lipids into injured arterial intima (fatty streaks stage). Once there, the lipids and fibrous tissues form a plaque, which narrows the vessel lumen and causes a reduction of blood flow to the cardiac muscle (fibrous plaque stage). This ischemia of the cardiac muscle can lead to the development of angina (complicated lesion stage). Plaque forms in lesions in the arteries. If the blockage of coronary arteries occurs slowly over time, there is a chance of collateral circulation occurring, in which new routes of blood circulation are formed to bypass blockages.
Angina pain is described as what type of sensation by most patients? Select all that apply. 1 Suffocating 2 Little to no pain 3 Dull substernal pain 4 Pain that radiates down the leg 5 Pain that radiates down the arm
Suffocating Little to no pain Dull substernal pain Pain that radiates down the arm Angina pain is described by most patients as suffocating, dull, substernal pain that radiates down the arm. Women with angina pain often describe the pain as weak or nonexistent. Pain that radiates down the leg is most often associated with back injury or sciatica pain.Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy.
Immediately following a patient's cardiac catheterization, what are the highest priority interventions when the patient returns to his room? Select all that apply. 1 Allowing the patient to rest 2 Taking the patient's vital signs 3 Administering oxygen via mask 4 Monitoring the ECG (electrocardiogram) 5 Assessing the pulses distal to the catheterization site
Taking the patient's vital signs Assessing the pulses distal to the catheterization site Nursing priority should be given to checking the pulses distal to the catheter insertion site, monitoring vital signs, and assessing the catheterization site for signs of bleeding. Patients do not generally require supplemental oxygen postcatheterization. Rest and monitoring the ECG are not the highest priorities when the patient returns from this procedure.
The nurse is participating in a care planning session for a patient who will be undergoing a heart transplant. The focus of the plan of care will revolve around which concern? Transplant rejection 2 Transplant pericarditis 3 Edema in the donor leg 4 Transplant Dressler syndrome
Transplant rejection Transplant rejection is a concern after heart transplantation. Pericarditis, edema in the donor leg, and Dressler syndrome are concerns related to coronary artery bypass grafting.Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer.
A 54-year-old man is admitted to the cardiac unit with chest pain radiating to his jaw and left arm. Which enzyme would be most specific in the diagnosis of a myocardial infarction (MI)? 1Troponin 2CK-MB (creatine kinase MB) 3LDH (L-lactate dehydrogenase) 4AST (aspartate aminotransferase
Troponin The most significant laboratory finding for diagnosis of MI is an elevated troponin level, especially if accompanied by an elevated CK-MB. Troponin is found only in cardiac tissue. LDH and AST are not the most significant laboratory findings for the diagnosis of MI.
A patient presents to the emergency department reporting severe, crushing chest pain. The health care provider suspects an acute myocardial infarction. Which laboratory test result will the nurse check to help confirm this diagnosis? 1. Troponin T 2 Lipid profile 3 Complete blood count 4 Arterial blood gases (ABGs)
Troponin T Troponin is a protein involved in the contraction of muscles. Two subtypes, troponin T (TnT) and troponin I (TnI), are specific to cardiac muscle and are released into the circulation after an acute myocardial infarction. This test is done in the emergency department because the results are available more quickly than the cardiac enzymes. A lipid profile is a battery of tests that measures the most common serum lipids: cholesterol, triglycerides, and lipoproteins. It does not measure for an infarction. ABGs are analyzed to determine the body's ability to maintain the acid-base balance, not an infarction. A complete blood count (CBC) is a basic screening test, not a test for infarction.
A patient who periodically experiences angina attacks should be provided with which instructions? Select all that apply. 1Avoid light physical activity. 2Wear warm clothing when exposed to cold weather. 3Obtain sufficient rest daily, and stop smoking. 4Take nitroglycerin before heavy physical activity. 5Limit meditation and deep relaxation techniques.
Wear warm clothing when exposed to cold weather. Obtain sufficient rest daily, and stop smoking. Take nitroglycerin before heavy physical activity. Patients with periodic angina attacks can be taught to do several things to help prevent those attacks. Among those things are avoiding exposure to cold weather, obtaining sufficient rest daily, stopping smoking, and taking nitroglycerin before heavy physical activity. Light activity should not be avoided; instead, a graduated exercise program should be encouraged. Meditation and deep relaxation techniques should be learned and used.
When is a temporary pacemaker used in a patient who has experienced a myocardial infarction? Select all that apply. 1 When a patient's heart rate stays at less than 40 bpm 2 When a patient's heart rate stays at greater than 120 bpm 3 When a patient experiences complete heart block 4 When a patient experiences ventricular fibrillation 5 When a patient experiences an irregular heartbeat
When a patient's heart rate stays at less than 40 bpm When a patient experiences complete heart block A temporary pacemaker may be inserted if the patient's heart rate drops to less than 40 beats per minute (not >120 bpm) and remains there or if the patient experiences complete heart block. A temporary pacemaker placement is not appropriate for irregular heartbeat or ventricular fibrillation.
When is coronary artery bypass graft surgery (CABG) considered for a patient? Select all that apply.
When angina cannot be controlled medically To prevent greater occlusion and consequent myocardial infarction CABG is performed when angina cannot be controlled medically or to prevent greater occlusion and consequent myocardial infarction. CABG is does not prevent stroke symptoms or coronary artery disease. CABG is not used to treat hypertension.
When is percutaneous transluminal coronary angioplasty (PTCA) used for a patient? 1 When heart transplantation is not possible 2When the patient experiences denial of his or her condition 3When a patient cannot afford coronary artery bypass surgery (CABG) 4When the patient has only one to two occlusions in the coronary arteries
When the patient has only one to two occlusions in the coronary arteries PTCA is used for a patient when the patient has only one to two occlusions in the coronary arteries. Heart transplantation is never considered if PTCA can be performed successfully. Denial is a common reaction that prevents many from seeking medical attention. PTCA is performed, if appropriate, during a cardiac catheterization because it is much less invasive than CABG. The fact that a patient cannot afford CABG is not the reason PTCA is used.
When must thrombolytic therapy be started to be effective for a myocardial infarction? 1 Immediately 2 Within 3 to 6 hours of the onset of symptoms 3 Within 6 to 12 hours of the onset of symptoms 4 Within 12 to 24 hours of the onset of symptoms
Within 6 to 12 hours of the onset of symptoms Thrombolytic therapy must be started within 6 to 12 hours of the onset of symptoms to be effective for a myocardial infarction.
What are some frequent patient emotional and behavioral responses to experiencing an acute myocardial infarction? Select all that apply. 1 Anger 2 Denial 3 Projection 4 Dependency 5 Anxiety and fear
anger denial dependency anxiety and fear Anger, denial, dependency, anxiety, and fear are common patient emotional and behavioral responses to having an acute myocardial infarction. Projection associated with a medical condition would be a defense mechanism in which a person would assign unwanted medical problems or pain to someone else. This is not a common response to an acute myocardial infarction.
