Question 1

Which of these nursing interventions included in the plan of care for a patient who had an AMI 3 days ago is most appropriate for the RN to delegate to an experienced LPN/LVN?

Accepted Answer

LPN/LVN education and scope of practice include safe administration of medications. Evaluating the patient response to exercise after an AMI requires more education and should be done by the RN. Teaching and discharge planning/documentation are higher level skills that require RN education and scope of practice.

Question 2

After having an AMI, a 62-year-old patient tells the nurse, "I guess having sex again will be too hard on my heart." The nurse's best response is

Accepted Answer

Sexual activity places about as much physical stress on the cardiovascular system as climbing two flights of stairs. The answer beginning "Sexual intercourse may be too strenuous" may be true; however there are no data in the stem to indicate that intercourse will be too stressful to the heart for this patient. The answer beginning, "You should discuss your questions" implies that there are serious medical concerns about sexual activity. And the answer beginning "Sexual activity can be resumed whenever" is incorrect because physiologic parameters such as heart rate and BP do increase during sexual activity.

Question 3

The nurse has just received change-of-shift report about these four patients. Which patient should the nurse assess first?

Accepted Answer

After PCI, the patient is at risk for bleeding from the arterial access site for the PCI, so the nurse should assess the patient immediately. The other patients also should be assessed as quickly as possible, but assessment of this patient has the highest priority.

Question 4

When evaluating the outcomes of preoperative teaching with a patient scheduled for a coronary artery bypass graft (CABG) using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says,

Accepted Answer

When the internal mammary artery is used, there will be no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.

Question 5

A few days after experiencing an MI, the patient states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which nursing intervention is appropriate to include in the nursing care plan?

Accepted Answer

Denial is a normal coping mechanism after an acute episode like an MI; waiting until the patient asks questions will improve the patient's ability to take in needed information. The patient should not be encouraged to leave for a vacation during the MI recovery period. Reminding the patient about the MI is likely to make the patient angry and lead to distrust of the nursing staff. The patient in denial will not be interested in learning about the normal functions of the heart.

Question 6

A patient is receiving fibrinolytic therapy 2 hours after developing an AMI. Which assessment information will be of most concern to the nurse?

Accepted Answer

The ongoing chest pain indicates continued myocardial injury and necrosis. The nurse should notify the physician. Bruising is a possible side effect of fibrinolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that fibrinolysis is occurring and perfusion is returning to the injured myocardium. An increase in cardiac enzyme levels is expected even with reperfusion.

Question 7

Three days after an MI, the patient develops chest pain that radiates to the back and left arm and is relieved by sitting in a forward position. On auscultation of the patient's chest, the nurse would expect to hear a

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 8

The nurse obtains the following data when caring for a patient who experienced an AMI 2 days previously. Which information is most important to report to the health care provider?

Accepted Answer

The crackles indicate that the patient may be developing heart failure, a possible complication of MI. The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme (ACE) inhibitors for the patient. The fever and elevated WBC are normal occurrences after MI as a result of inflammation that occurs after tissue necrosis. Denial is a common response in the immediate period after the MI.

Question 9

When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an AMI, the nurse will anticipate teaching the patient

Accepted Answer

Holter monitoring is used to determine whether the patient is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur. Heparin will not have any effect on the incidence of SCD, which can occur even when the patient is resting.

Question 10

After the nurse teaches a patient with chronic stable angina about how to use the prescribed nitrates, which statement by the patient 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. Nitrates should be stored in a dark place to avoid deterioration of the medication.

Question 11

During the administration of the fibrinolytic agent to a patient with an 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 fibrinolytic therapy. Bleeding of the gums and prolonged bleeding from IV sites are expected side effects of the therapy. The nurse should address these by avoiding any further injuries, but they are not an indication to stop infusion of the fibrinolytic medication. A nonsustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective.

Question 12

For a patient who has been admitted the previous day to the coronary care unit with an AMI, the nurse will anticipate teaching the patient about

Accepted Answer

At this time, the patient's anxiety level or denial will prevent good understanding of complex information such as CAD pathophysiology. Teaching about discharge medications should be done when the time for discharge is closer. The nurse should support the patient by decreasing anxiety rather than discussing the typical emotional response to MI.

Question 13

A patient who has chest pain is admitted to the ED, and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first?

Accepted Answer

The priority for the patient is to determine whether an AMI is occurring so that reperfusion therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion. Troponin levels will increase after about 3 hours. Data from the CT scan and chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing an MI.

Question 14

A patient who has recently started taking rosuvastatin (Crestor) and niacin (Nicobid) reports all the following symptoms to the nurse. Which is most important to communicate to the health care provider?

Accepted Answer

Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute renal failure and death in some patients who have taken the statin medications. These symptoms indicate that the rosuvastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and, although the nurse should follow up with the patient, do not indicate that a change in medication is needed.

Question 15

Two days after having an MI, a patient tells the nurse, "I wish I had died when I had this heart attack. I won't be able to do anything now." The most appropriate nursing diagnosis is

Accepted Answer

The patient's statements indicate that the perceived change in role is the major concern. The patient is experiencing progression through the normal stages of loss and grief that often occur after an MI, so ineffective coping is not an appropriate diagnosis. There is no evidence to support an unwillingness to alter lifestyle or ineffective health maintenance.

Question 16

A patient with hyperlipidemia has a new order for the bile-acid sequestrant medication colesevelam (Welchol). Which nursing action is appropriate when giving the medication?

Accepted Answer

The bile-acid sequestrants interfere with the absorption of other drugs, and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the Welchol may increase the incidence of gastrointestinal side effects such as heartburn. An increased fluid intake is encouraged for patients taking the bile-acid sequestrants to reduce the risk for constipation. For maximum effect, Welchol should be administered with meals.

Question 17

A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patient's care?

Accepted Answer

The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using Viagra because of the risk of sudden death caused by vasodilation. The other home medications should also be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.

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