Question 1

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?

Accepted Answer

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.

Question 2

The patient is admitted with a suspected acute myocardial infarction (AMI).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)?

Accepted Answer

ST segment elevation and elevated cardiac enzymes are seen in Q wave MI.

Question 3

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?

Accepted Answer

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.Because interventional cardiology is unavailable,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.

Question 4

A patient has elevated blood lipids.The nurse anticipates which classification of drugs to be prescribed for the patient?

Accepted Answer

The statins have been found to lower low-density lipoproteins (LDLs)more than other types of lipid-lowering drugs such as bile acid resins and nicotinic acid.Nitroglycerin is used for chest pain.

Question 5

A patient has been prescribed nitroglycerin (NTG)in the ED for chest pain.In taking the health history,the nurse will be sure to verify whether the patient has taken medications before admission for:

Accepted Answer

A history of the patient's use of sildenafil citrate 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 other conditions would not be a contraindication for nitroglycerin.

Question 6

The nurse is assessing a patient with left-sided heart failure.Which symptom would the nurse expect to find?

Accepted Answer

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.

Question 7

A patient 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?

Accepted Answer

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 ECG provides information related to the heart's electrical activity.A cardiac catheterization directly visualizes coronary arteries.Electrophysiology studies are done to evaluate dysrhythmias.

Question 8

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?

Accepted Answer

Some individuals may have ischemic episodes without knowing it,thereby having a "silent" infarction.These can occur with no presenting signs or symptoms; however,the patient's troponin levels and ECG are consistent with an MI.Asymptomatic or nontraditional symptoms are more common in elderly persons,in women,and in diabetic patients.The patient does not fit the criteria for hypokalemia,a non-Q wave MI,or unstable angina.

Question 9

The patient presents to the ED with sudden,severe sharp chest discomfort,radiating to the back and down both arms,as well as numbness in the 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:

Accepted Answer

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.

Question 10

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?

Accepted Answer

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.

Question 11

The provider prescribes a pharmacological stress test for a patient with activity intolerance.The nurse would anticipate that the drug of choice would be

Accepted Answer

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.Dopamine and atropine are not used.

Question 12

A patient presents to the emergency department ( ED )with chest pain that he has had for the past 2 hours.The patient is nauseated and diaphoretic,with dusky skin color.The electrocardiogram shows ST elevation in leads II,III,and aVF.Which therapeutic intervention would the nurse question?

Accepted Answer

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.

Question 13

Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink?

Accepted Answer

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.The other tests do not alter the gag reflex.

Question 14

A patient is admitted with an acute myocardial infarction (AMI).The nurse knows that an angiotensin-converting enzyme (ACE)inhibitor should be started within 24 hours to reduce the incidence of which process?

Accepted Answer

Myocardial remodeling is a process mediated by angiotensin II,aldosterone,catecholamine,adenosine,and inflammatory cytokines; it 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.

Question 15

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?

Accepted Answer

Radiofrequency catheter ablation is a method of interrupting a supraventricular tachycardia,a dysrhythmia caused by a reentry circuit,and an abnormal conduction pathway.A cardioverter-defibrillator is used on patients with potentially lethal rhythms such as ventricular fibrillation.A pacemaker is not used for this condition.

Question 16

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?

Accepted Answer

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.Complete occlusion is associated with a myocardial infarction.A fatty streak is present in all vessels affected by coronary artery disease.Vasospasm leads to Prinzmetal's angina.

Question 17

While instructing a patient on what occurs with a myocardial infarction,the nurse plans to explain which process?

Accepted Answer

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.Coronary artery spasms and transient oxygen imbalance are not related to a myocardial infarction.Ischemia,if not reversed,will eventually lead to tissue necrosis.

Question 18

The patient presents to the ED with severe chest discomfort.A cardiac catheterization and angiography shows an 80% occlusion of the left main coronary artery.Which procedure will be most likely performed on this patient?

Accepted Answer

Coronary artery bypass graft surgery is indicated for significant left main coronary occlusion (>50%).The stent or PTCA are not appropriate because the patient is a candidate for CABG.The transmyocardial revascularization is reserved for patients who do not have other treatment options.

Question 19

A patient presents to the ED complaining of severe substernal chest pressure radiating to the left shoulder and back that started about 12 hours ago.The patient delayed coming to the ED,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.What does the nurse understand about thrombolysis in this patient?

Accepted Answer

To be eligible for thrombolysis,the patient must be symptomatic for less than 12 hours.Therefore,this patient is not a candidate for this therapy.

Question 20

A patient is admitted with angina.The nurse anticipates which drug regimen to be initiated?

Accepted Answer

Conservative intervention for the patient experiencing angina includes nitrates,beta blockers,and oxygen.

Quiz 13: Cardiovascular Alterations

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?

The patient is admitted with a suspected acute myocardial infarction (AMI) .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) ?