Question 1

A patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. 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.

Question 2

During the administration of the fibrinolytic 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 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 3

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

Accepted Answer

Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., amlodipine, nifedipine [Procardia]) are a first-line therapy for this type of angina. Platelet inhibitors, such as aspirin, help prevent coronary artery thrombosis, and b-blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

Question 4

After the nurse teaches a patient with chronic stable angina about how to use the prescribed short-acting and long-acting 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. Although the nurse should check blood pressure before giving nitroglycerin, patients do not need to check the pulse rate before taking nitrates.

Question 5

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

Accepted Answer

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

Question 6

Which information collected by the nurse who is admitting a patient with chest pain suggests 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 pericarditis or musculoskeletal pain. Stable angina is usually relieved when the patient takes nitroglycerin.

Question 7

A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests 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). 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 8

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 9

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

Accepted Answer

A change in heart rate of more than 20 beats or more 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 10

Nadolol ( Corgard ) is prescribed for a patient with angina. 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 (BP) and apical pulse rate may decrease, but these data do not indicate that the goal of decreased angina has been met. The noncardioselective b-blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in peripheral pulse quality or skin temperature.

Question 11

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

Accepted Answer

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

Question 12

Which of these statements made by a patient with coronary artery disease after the nurse has completed teaching about the 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 13

When administering IV nitroglycerin (Tridil) to 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 BP and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective.

Question 14

To assist the patient with coronary artery disease ( CAD ) in making appropriate dietary changes, which of these nursing interventions will be most effective?

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. Removing saturated fat from the diet completely 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 15

When caring for a patient who has survived a sudden cardiac death ( SCD ) event and has no evidence of an acute myocardial infarction ( 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, and SCD can occur even when the patient is resting.

Question 16

After the nurse has finished teaching a patient about 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 5 minutes after taking one nitroglycerin. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset is not an expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis.

Question 17

When developing a health teaching plan for a 60-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 18

Three days after a myocardial infarction (MI), the patient develops chest pain 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 19

A patient with ST segment elevation in several 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 fibrinolytic therapy?

Accepted Answer

Fibrinolytic 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 also will be needed, but it will not be a factor in the decision about fibrinolytic therapy.

Question 20

Four days after having a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with all the daily 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 indicates 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 social isolation.

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

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

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

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

After the nurse teaches a patient with chronic stable angina about how to use the prescribed short-acting and long-acting nitrates, which statement by the patient indicates that the teaching has been effective?

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

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

A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI) . Which of these ordered laboratory tests 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?

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

Nadolol ( Corgard ) is prescribed for a patient with angina. To determine whether the drug is effective, the nurse will monitor for

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

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

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

To assist the patient with coronary artery disease ( CAD ) in making appropriate dietary changes, which of these nursing interventions will be most effective?

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

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

When developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease ( CAD ) , the nurse should focus on the

Three days after a myocardial infarction (MI) , the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next?

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