Deck 58: Management of Clients with Myocardial Infarction

Question 1

When the nurse notes a run of four premature ventricular contractions (PVCs) on the monitor of a client with a recent MI, the nurse would

A) administer sublingual nitroglycerin.
B) change the client's ECG leads.
C) continue observing for six PVCs or more.
D) notify the physician immediately.

Answer 1

continue observing for six PVCs or more.

Question 2

For a client whose resting pulse rate is 71 beats/min, the nurse would check the client's pulse rate to ensure that during post-MI activities, the client's heart rate does not exceed

A) 89 beats/min.
B) 96 beats/min.
C) 101 beats/min.
D) 112 beats/min.

Answer 2

89 beats/min.

Question 3

The nurse would explain to a client that increased levels of troponin I are evident within

A) 1 to 2 hours after MI pain has started.
B) 3 to 12 hours after MI pain has started.
C) 7 to 9 hours after MI pain has started.
D) 12 to 15 hours after MI pain has started.

Answer 3

3 to 12 hours after MI pain has started.

Question 4

After instructing a client with stable angina, the nurse would evaluate that the client has a proper understanding of the condition when the client says

A) "Angina pain usually feels like being stabbed with a knife."
B) "Each time I have angina, my heart is damaged."
C) "If I have chest pain, then I'm probably having another heart attack."
D) "My chest pain can occur if I overexert myself."

Question 5

When caring for a client immediately after an MI, the nurse's first priority would be

A) monitoring for dysrhythmias.
B) preventing an embolism.
C) relieving pain.
D) relieving the client's apprehension.

Question 6

A client is scheduled for the "early release" discharge after suffering an STEMI. Which action by the nurse would most facilitate a successful outcome after discharge?

A) Arranging to have all medications delivered to the home
B) Referring the client for home health care visits
C) Reviewing the client's medications before discharge
D) Teaching the client to monitor his/her own blood pressure

Question 7

The nurse would remind a client that the cause of sudden death after myocardial infarction is usually

A) congestive heart failure.
B) dysrhythmias.
C) myocardial ischemia.
D) stroke.

Question 8

In the discharge teaching plan for a client after MI, the nurse would include that the client should

A) begin walking for short periods every day.
B) continue previous lifestyle when ready.
C) resume sexual intercourse in 3 months.
D) take 1 aspirin every 8 hours as ordered.

Question 9

Four hours after the onset of pain from an MI, the nurse would expect an increase in which laboratory result?

A) Alkaline phosphatase (ALP)
B) CK-MB
C) Lactate dehydrogenase (LDH)
D) Leukocyte count

Question 10

The nurse would explain to a client that the most common site for MI is the

A) anterior wall of the left ventricle.
B) anterior wall of the right ventricle.
C) inferior (diaphragmatic) surface.
D) posterior wall of the left ventricle.

Question 11

A nurse is visiting a client in the home 3 weeks after having an STEMI. The client appears distressed and the spouse is nervously hovering nearby. Which assessment by the nurse would provide the most useful data? The nurse should inquire if

A) neighbors have been dropping by and fatiguing the client.
B) the client is able to adhere to the prescribed exercise routine.
C) the spouse is able to shop for and prepare appropriate foods.
D) there are fears that allowing the client activity may provoke another MI.

Question 12

For a 40-year-old client who wants to be more active the first 24 hours after an MI, the nurse could safely suggest that the client

A) ambulate in the hall with supervision.
B) perform gentle isometric exercises.
C) take a bath in the shower.
D) use the bedside commode for bowel movements.

Question 13

In order to be most effective, the nurse planning a new cardiac rehabilitation program for the community hospital realizes to be most successful, the program

A) cannot begin until the clients go home.
B) needs to be cost-effective.
C) only should address physical problems.
D) should use a case management approach.

Question 14

A nurse is reinforcing diet teaching done by the dietitian. The nurse would evaluate that some goals have been met when the client admitted for angina requests which foods for breakfast?

A) Bran flakes with skim milk, apple slices, and orange juice
B) French toast with syrup, grapefruit half, and skim milk
C) Oatmeal with skim milk, one bacon slice, and hot tea
D) Scrambled eggs, whole-wheat toast, and prune juice

Question 15

A home health care nurse is visiting a client who was dismissed after having an STEMI (ST-elevation myocardial infarction). The nurse is reinforcing teaching done while the client was hospitalized. When the nurse asks the client if he/she has any more questions, the client says no but appears anxious. The best action by the nurse would be to

A) ask the client if he/she has questions about resuming sexual activity.
B) find out if the client is worried about being at home instead of in the hospital.
C) inquire about the feasibility of the client returning to his/her old job after recovery.
D) speak with the spouse privately to see if she/he knows why the client is anxious.

Question 16

A client admitted for angina reports experiencing pain of long duration while at rest and also early in the morning. The nurse would recognize this pattern as

A) angina decubitus.
B) nocturnal angina.
C) unstable angina.
D) variant angina.

Question 17

A client presents to the emergency department complaining of chest pain that began 2 hours earlier; the client's electrocardiogram (ECG) is consistent with acute myocardial infarction. The nurse would know that the standard treatment at this time is

A) diazepam.
B) lidocaine.
C) streptokinase.
D) verapamil.

Question 18

A nurse is instructing a client in the proper administration of sublingual nitroglycerin (NTG). The nurse would include in the teaching plan information that the client should

A) assess blood pressure for reactive hypertension after each dose.
B) repeat the dosage every 5 minutes for three times if pain is not relieved.
C) store NTG tablets in the refrigerator for up to 6 months.
D) take an aspirin before taking the first dose of NTG.

Question 19

A client has received thrombolytic therapy after an ST segment myocardial infarction (STEMI). A half-hour later, the nurse notices frequent PVCs. The most appropriate action by the nurse is to

A) administer lidocaine per the dysrhythmia protocol.
B) document the finding and conclude the therapy worked.
C) prepare to send the client for emergent PTCA.
D) request an order for an anxiolytic medication.

Question 20

When the immediate post-MI client complains about the high-fiber diet and being encouraged to drink water, the nurse would inform the client that the purpose of such a diet is to

A) create a high-bulk, soft stool.
B) lower cholesterol levels.
C) maintain bowel health to decrease gas.
D) promote easy digestion.

Question 21

A client is being evaluated in the emergency department for possible thrombolytic therapy to treat an STEMI. The nurse assesses a relative contraindication for this treatment, which is

A) aortic aneurysm.
B) known intracranial tumor.
C) pregnancy.
D) previous hemorrhagic stroke.

Question 22

A client with recurrent angina is being treated with aspirin, 81 mg/day. When the client asks why the aspirin is needed, the best response by the nurse is to say "Aspirin

A) keeps platelets from sticking together and forming a clot."
B) prevents the fever that goes along with angina."
C) treats the pain of angina without dropping your blood pressure."
D) will reduce the inflammation in your heart."

Question 23

A client newly diagnosed with STEMI has the nursing diagnosis Anxiety related to hospital admission. The nurse assesses that goals have been met when the client

A) continues to ask questions.
B) cries openly while the nurse is there.
C) is able to rest quietly.
D) needs repetition of information.

Question 24

The nursing actions that would most help to prevent cardiogenic shock in a client after a myocardial infarction are (Select all that apply)

A) administering vasopressor agents.
B) enhancing the heart's pumping function.
C) giving the client IV lidocaine.
D) providing adequate IV fluids.
E) treating pain rapidly.

Question 25

A client in intensive care has had an STEMI. The client is alternately yelling out and crying. The client states "I'll never be able to go back to work again!" The most appropriate nursing diagnosis for this client is

A) Altered Body Image.
B) Anxiety.
C) Fear.
D) Powerlessness.