Question 1

A patient with ST-segment elevation in three contiguous electrocardiographic (ECG)leads is admitted to the emergency department (ED)and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI).Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?

Accepted Answer

Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI),so the time at which the chest pain started is a major determinant of the appropriateness of this treatment.The other information will also be needed,but it will not be a factor in the decision about thrombolytic therapy.

Question 2

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD),the nurse should focus on the

Accepted Answer

Because family history,gender,and age are nonmodifiable risk factors,the nurse should focus on the patient's LDL level.Decreases in LDL will help reduce the patient's risk for developing CAD.

Question 3

When titrating IV nitroglycerin (Tridil)for a patient with a myocardial infarction (MI),which action will the nurse take to evaluate the effectiveness of the medication?

Accepted Answer

The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand.The nurse also will monitor heart rate and blood pressure (BP)and observe for dysrhythmias,but these parameters will not indicate whether the medication is effective.

Question 4

Following an acute myocardial infarction (AMI),a patient ambulates in the hospital hallway.When the nurse is evaluating the patient's response to the activity,which assessment data would indicate that the exercise level should be decreased?

Accepted Answer

A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest.The increases in BP and respiratory rate,and the slight decrease in oxygen saturation,are normal responses to exercise.

Question 5

When caring for a patient who is recovering from a sudden cardiac death (SCD)event and has no evidence of an acute myocardial infarction (AMI),the nurse will anticipate teaching the patient that

Accepted Answer

Diagnostic testing (e.g.,stress test,Holter monitor,electrophysiologic studies,cardiac catheterization)is used to determine the possible cause of the SCD and treatment options.SCD is likely to recur.Anticoagulation therapy will not have any effect on the incidence of SCD,and SCD can occur even when the patient is resting.

Question 6

Three days after experiencing a myocardial infarction (MI),a patient who is scheduled for discharge asks for assistance with hygiene activities,saying,"I am too nervous to take care of myself." Based on this information,which nursing diagnosis is appropriate?

Accepted Answer

The patient data indicate that ineffective coping after the MI caused by anxiety about the impact of the MI is a concern.The other nursing diagnoses may be appropriate for some patients after an MI,but the data for this patient do not support denial,activity intolerance,or disturbed personal identity.

Question 7

In preparation for discharge,the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates.Which patient statement indicates that the teaching has been effective?

Accepted Answer

The patient should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension.Transdermal nitrates are used prophylactically rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin.Although the nurse should check blood pressure before giving nitroglycerin,patients do not need to check the pulse rate before taking nitrates.

Question 8

Which nursing intervention will be most effective when assisting the patient with coronary artery disease (CAD)to make appropriate dietary changes?

Accepted Answer

Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences.The highest percentage of calories from fat should come from monosaturated fats.Although low-sodium and low-cholesterol foods are appropriate,providing the patient with a list alone is not likely to be successful in making dietary changes.Completely removing saturated fat from the diet is not a realistic expectation.Up to 7% of calories in the therapeutic lifestyle changes (TLC)diet can come from saturated fat.Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful.

Question 9

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about therapeutic lifestyle changes (TLC)diet indicates that further teaching is needed?

Accepted Answer

Although only 30% of the daily calories should come from fats,most of the fat in the TLC diet should come from monosaturated fats such as are found in nuts,olive oil,and canola oil.The patient can include peanut butter sandwiches as part of the TLC diet.The other patient comments indicate a good understanding of the TLC diet.

Question 10

Diltiazem (Cardizem)is ordered for a patient with newly diagnosed Prinzmetal's (variant)angina.When teaching the patient,the nurse will include the information that diltiazem will

Accepted Answer

Prinzmetal's angina is caused by coronary artery spasm.Calcium channel blockers (e.g.,diltiazem,amlodipine [Norvasc])are a first-line therapy for this type of angina.Lipid-lowering drugs help reduce atherosclerosis (i.e.,plaque formation),and b-adrenergic blockers decrease sympathetic stimulation of the heart (i.e.,palpitations).Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

Question 11

A patient is recovering from a myocardial infarction (MI)and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward.Which action should the nurse take next?

Accepted Answer

The patient's symptoms are consistent with the development of pericarditis,a possible complication of MI.The other assessments listed are not consistent with the description of the patient's symptoms.

Question 12

Nadolol (Corgard)is prescribed for a patient with chronic stable angina and left ventricular dysfunction.To determine whether the drug is effective,the nurse will monitor for

Accepted Answer

Because the medication is ordered to improve the patient's angina,effectiveness is indicated if the patient is able to accomplish daily activities without chest pain.Blood pressure and heart rate may decrease,but these data do not indicate that the goal of decreased angina has been met.The noncardioselective b-adrenergic blockers can cause peripheral vasoconstriction,so the nurse would not expect an improvement in distal pulse quality or skin temperature.

Question 13

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor)if the

Accepted Answer

Patients taking b-adrenergic blockers should be monitored for hypotension and bradycardia.Because this class of medication inhibits the sympathetic nervous system,restlessness,agitation,hypertension,and anxiety will not be side effects.

Question 14

After the nurse teaches the patient about the use of carvedilol (Coreg)in preventing anginal episodes,which statement by a patient indicates that the teaching has been effective?

Accepted Answer

Patients who have been taking b-adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued.Carvedilol (Coreg)decreases myocardial contractility.Shortness of breath that occurs when taking b-adrenergic blockers for angina may be due to bronchospasm and should be reported to the health care provider.Carvedilol works by decreasing myocardial oxygen demand,not by increasing blood flow to the coronary arteries.

Question 15

Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction (AMI)?

Accepted Answer

Chest pain that lasts for 20 minutes or more is characteristic of AMI.Changes in pain that occur with raising the arms or with deep breathing are more typical of musculoskeletal pain or pericarditis.Stable angina is usually relieved when the patient takes nitroglycerin.

Question 16

During the administration of the thrombolytic agent to a patient with an acute myocardial infarction (AMI),the nurse should stop the drug infusion if the patient experiences

Accepted Answer

The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding,a possible complication of thrombolytic therapy.Some bleeding of the gums is an expected side effect of the therapy but not an indication to stop infusion of the thrombolytic medication.A decrease in blood pressure could indicate internal bleeding.A nonsustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective.

Question 17

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI).Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI?

Accepted Answer

Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI)and are highly specific indicators for MI.Myoglobin is released within 2 hours of MI,but it lacks specificity and its use is limited.The other laboratory data are useful in determining the patient's risk for developing coronary artery disease (CAD)but are not helpful in determining whether an acute MI is in progress.

Question 18

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?

Accepted Answer

Chronic stable angina is typically relieved by rest or nitroglycerin administration.The level of pain is not a consistent indicator of the type of angina.Pain occurring at rest or with increased frequency is typical of unstable angina.

Question 19

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat),which patient statement indicates that the teaching has been effective?

Accepted Answer

The emergency medical services (EMS)system should be activated when chest pain or other symptoms are not completely relieved after 3 sublingual nitroglycerin tablets taken 5 minutes apart.Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g.,before intercourse).Gastric upset (e.g.,nausea)is not an expected side effect of nitroglycerin.Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis.

Question 20

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI).What is the purpose of the heparin?

Accepted Answer

Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis.It does not change coronary artery plaque,dissolve already formed clots,or enhance platelet aggregation.

Quiz 34: Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD) ,the nurse should focus on the

When titrating IV nitroglycerin (Tridil) for a patient with a myocardial infarction (MI) ,which action will the nurse take to evaluate the effectiveness of the medication?

Following an acute myocardial infarction (AMI) ,a patient ambulates in the hospital hallway.When the nurse is evaluating the patient's response to the activity,which assessment data would indicate that the exercise level should be decreased?

When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI) ,the nurse will anticipate teaching the patient that

Three days after experiencing a myocardial infarction (MI) ,a patient who is scheduled for discharge asks for assistance with hygiene activities,saying,"I am too nervous to take care of myself." Based on this information,which nursing diagnosis is appropriate?

In preparation for discharge,the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates.Which patient statement indicates that the teaching has been effective?

Which nursing intervention will be most effective when assisting the patient with coronary artery disease (CAD) to make appropriate dietary changes?

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed?

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina.When teaching the patient,the nurse will include the information that diltiazem will

A patient is recovering from a myocardial infarction (MI) and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward.Which action should the nurse take next?

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction.To determine whether the drug is effective,the nurse will monitor for

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the

After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes,which statement by a patient indicates that the teaching has been effective?

Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction (AMI) ?

During the administration of the thrombolytic agent to a patient with an acute myocardial infarction (AMI) ,the nurse should stop the drug infusion if the patient experiences

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI) .Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI?

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat) ,which patient statement indicates that the teaching has been effective?

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) .What is the purpose of the heparin?