Question 1

The nurse is caring for a post-myocardial infarction (MI)patient.The patient questions the reason for a stool softener and denies constipation.Which statement indicates that the patient accurately understands the nurse's teaching?

Accepted Answer

Bearing down or straining at stool can stimulate the vagal nerve and induce bradycardia.

Question 2

The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI).The nurse recognizes this finding indicates which problem?

Accepted Answer

Friction rubs occur in pericarditis when the inflamed area of the infarct rubs the pericardium.

Question 3

The nurse is caring for a post-myocardial infarction (MI)patient who has been started on daily simvastatin (Zocor)and a low-fat diet.Which statement best indicates that the nurse's teaching has been successful?

Accepted Answer

Statins can injure muscle tissue and are toxic to the liver in some patients.Patients should report any unexplained muscle tenderness or pain persisting for more than a few days.Laboratory tests for liver enzymes are recommended at the start of therapy and only when clinically indicated.Grapefruit juice interferes with drug metabolism and should be avoided to prevent increased risk of toxicity.Zocor can be taken without regard to meals.

Question 4

The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed.Which response by the nurse is most accurate?

Accepted Answer

Most physicians use an arterial closure device at the puncture site,which enables the patient to be ambulatory within 2 hours after the cardiac catheterization procedure.The patient may be turned to either side.Sandbags were used in the past to prevent bleeding from the puncture site and the patient had to lay flat for several hours.Flexing and extending the legs immediately after the procedure would likely cause bleeding from the site.

Question 5

The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB).Which statement indicates that the patient needs further instruction?

Accepted Answer

The MIDCAB procedure is less invasive than the traditional coronary artery bypass graft (CABG)procedure and does not require the patient be placed on the heart-lung machine due to stopping the heart for an extended period.Both procedures are used to treat angina that has not responded to more conservative treatment and utilize either the mammary artery or sections of the saphenous vein for the graft.

Question 6

The nurse is caring for a 38-year-old African American patient with diabetes.The patient manages her diabetes with dietary control,takes oral contraceptives,and is a nonsmoker.Which characteristic(s)in this patient's history increase the patient's risk for coronary artery disease (CAD)?

Accepted Answer

African Americans have an ethnic tendency to CAD.Taking birth control pills and diabetes are both risk factors for CAD.Older patients are at increased risk for CAD,and a nonsmoking status decreases the likelihood of developing CAD.

Question 7

The nurse is educating a patient on a low-fat,low-cholesterol diet after a myocardial infarction (MI).Which food choice should the nurse recommend?

Accepted Answer

Fish have a high content of omega-3 fatty acids,which are helpful in reducing cholesterol.Not all frozen foods are unhealthy.Frozen vegetables with no sodium added are a good choice for a low-fat,low-cholesterol diet.Nondairy creamer is high in trans fat and saturated fat.Grapefruit juice often interferes with metabolism of a variety of medications.

Question 8

The nurse is caring for a patient with uncontrolled hypertension,diabetes,asthma,and gastroesophageal reflux disease (GERD).Which problem serves as a contraindication for a thrombolytic agent?

Accepted Answer

Thrombolytic agents are contraindicated in people with uncontrolled hypertension,GI bleeds,recent intracranial or intraspinal surgery,or aneurysm because of threat of excessive bleeding.

Question 9

The nurse is caring for a patient with agina pectoris who asks what happens to make his body experience pain.The nurse explains that pain results from which underlying causative factor?

Accepted Answer

Angina pectoris (chest pain)occurs when blood supply to the heart is decreased or totally obstructed.Pain results from ischemia (inadequate blood and oxygen supply).

Question 10

The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary angiography earlier in the day.The patient denies pain and no longer requires bed rest.The groin is soft with no palpable hematoma.Which postprocedure care is most important for the patient at this time?

Accepted Answer

The procedure uses a large volume of dye,which can be harmful to the kidneys.Increasing fluid intake is the priority focus for care at this time after hemostasis is obtained.Keeping the patient hydrated increases the rate of urine flow,dilutes the urine,and helps prevent kidney damage as the contrast is excreted.The patient denies pain.Vital signs are taken every 15 minutes for the first hour and are checked progressively less frequently unless there is evidence of bleeding or instability.The patient can now ambulate,but ambulation is a lesser priority than flushing out the hypertonic dye.

Question 11

The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful.Which reply is best?

Accepted Answer

Daily doses of aspirin reduce clotting by prolonging clotting time,thus helping prevent clots that can cause an MI.

Question 12

The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI).The nurse observes that the patient is experiencing electrocardiogram (ECG)changes and reviews new laboratory results.Which laboratory value should the nurse report immediately?

Accepted Answer

The patient has a significantly elevated troponin.The abnormal troponin,along with ECG changes,indicates that the patient is likely experiencing an MI.(Elevated troponin levels are most indicative of an MI as these enzymes are specific to heart muscle damage.)While the nurse should report the abnormally low potassium of 3.4 (low normal)sodium,these findings are of lesser priority than the elevated troponin.

Question 13

A patient who presented to the emergency room with a myocardial infarction (MI)becomes pale,diaphoretic,and hypotensive.What action should the nurse take first?

Accepted Answer

If the left ventricle is badly damaged,cardiogenic shock may occur.Signs and symptoms are those that accompany decreased cardiac output,such as decreased BP,confusion,restlessness,diaphoresis,rapid and thready pulse,increased respiratory rate,cold and clammy skin,and diminishing urinary output to less than 20 mL/hr.This condition is a medical emergency that requires immediate notification of the physician.The nurse should then ensure that the IV is patent.Respiratory therapy assistance will likely be beneficial,especially if the patient's condition further deteriorates.The nurse should finally notify the patient's family about the change in status.

Question 14

The drug alteplase (t-PA)is given to the patient with a myocardial infarction (MI).Which statement accurately describes the purpose of this medication?

Accepted Answer

Alteplase (t-PA)is a thrombolytic drug that will dissolve the clot if given within 12 hours of the MI.

Question 15

The patient being evaluated for a heart transplant asks the nurse what the survival rate is.Which response is best for the nurse to make?

Accepted Answer

Identifying that individual cases vary while giving accurate statistics is the most helpful response.Stating "I'm not really sure" does not instill confidence in the nurse's ability or knowledge.Although a significant number of patients live past 10 years following heart transplant,responding that almost all patients live past 10 years is inaccurate and instills false hope.

Question 16

The nurse is explaining the difference between exertional angina and unstable angina.Which statement about unstable angina is accurate?

Accepted Answer

Unstable angina attacks are unpredictable and do not follow a pattern,as do stable angina attacks.Unstable angina can progress into a myocardial infarction (MI)and a medical emergency.

Question 17

The nurse is caring for a female patient with a family history of heart disease who is undergoing a workup for cardiovascular disease.Which finding is most concerning to the nurse?

Accepted Answer

Women frequently experience fatigue with heart disease.Many women do not even experience chest pain.Fainting,dry mouth,and dizziness are not typical signs of heart disease in women.

Question 18

The nurse is caring for a male patient with angina who has a new prescription for sublingual nitroglycerin.What information is most important for the nurse to include in the teaching plan?

Accepted Answer

Sublingual nitroglycerin tablets should be kept in a cool,dark place and should be carried by the patient at all times.If chest pain persists after the first dose,the patient should repeat the dose in 5 minutes.The patient should contact emergency services,not the physician.Nitroglycerin may cause an unsafe drop in blood pressure (BP)if combined with certain medications for erectile dysfunction.

Question 19

How does a myocardial infarction (MI)alter the pumping efficiency of the heart?

Accepted Answer

Myocardial necrosis (damaged or dead heart muscle tissue)cannot contract effectively,which decreases pumping efficiency (cardiac output).

Question 20

The 60-year-old female in the post-coronary care unit confides to the nurse,"My life is over.I'll never be able to care for my family,take a vacation,or work in my garden." Which response is most supportive?

Accepted Answer

Helping patients identify and face depression is helpful in dispelling it,and talking about her concerns will open up conversation and address the concerns in a problem-solving approach.Telling her that she will be able to resume all activities may be instilling false hope.Medication is not warranted at this point.

Quiz 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery

The nurse is caring for a post-myocardial infarction (MI) patient.The patient questions the reason for a stool softener and denies constipation.Which statement indicates that the patient accurately understands the nurse's teaching?

The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI) .The nurse recognizes this finding indicates which problem?

The nurse is caring for a post-myocardial infarction (MI) patient who has been started on daily simvastatin (Zocor) and a low-fat diet.Which statement best indicates that the nurse's teaching has been successful?

The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed.Which response by the nurse is most accurate?

The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB) .Which statement indicates that the patient needs further instruction?

The nurse is caring for a 38-year-old African American patient with diabetes.The patient manages her diabetes with dietary control,takes oral contraceptives,and is a nonsmoker.Which characteristic(s) in this patient's history increase the patient's risk for coronary artery disease (CAD) ?

The nurse is educating a patient on a low-fat,low-cholesterol diet after a myocardial infarction (MI) .Which food choice should the nurse recommend?

The nurse is caring for a patient with uncontrolled hypertension,diabetes,asthma,and gastroesophageal reflux disease (GERD) .Which problem serves as a contraindication for a thrombolytic agent?

The nurse is caring for a patient with agina pectoris who asks what happens to make his body experience pain.The nurse explains that pain results from which underlying causative factor?

The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful.Which reply is best?

The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI) .The nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new laboratory results.Which laboratory value should the nurse report immediately?

A patient who presented to the emergency room with a myocardial infarction (MI) becomes pale,diaphoretic,and hypotensive.What action should the nurse take first?

The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI) .Which statement accurately describes the purpose of this medication?

The patient being evaluated for a heart transplant asks the nurse what the survival rate is.Which response is best for the nurse to make?

The nurse is explaining the difference between exertional angina and unstable angina.Which statement about unstable angina is accurate?

The nurse is caring for a female patient with a family history of heart disease who is undergoing a workup for cardiovascular disease.Which finding is most concerning to the nurse?

The nurse is caring for a male patient with angina who has a new prescription for sublingual nitroglycerin.What information is most important for the nurse to include in the teaching plan?

How does a myocardial infarction (MI) alter the pumping efficiency of the heart?

The 60-year-old female in the post-coronary care unit confides to the nurse,"My life is over.I'll never be able to care for my family,take a vacation,or work in my garden." Which response is most supportive?