Question 1

The nurse, caring for a patient diagnosed with Prinzmetal's or variant angina, realizes this is a serious type of chest pain. Why is this so?

Accepted Answer

Prinzmetal's or variant angina is a type of chest pain caused by the sudden constriction or spasm of coronary arteries, resulting in reduced blood flow to the heart muscle. This can lead to a myocardial infarction if left untreated, making it a serious condition. Associated renal or pulmonary diseases are not typically related to Prinzmetal's angina.

Question 2

Aspirin has been prescribed for a patient following a myocardial infarction. What should the nurse include in teaching about this drug?

Accepted Answer

Aspirin can interact with certain herbal remedies, potentially increasing the risk of bleeding, so it's important to consult a healthcare provider before taking any.

Question 3

Following a transmural myocardial infarction, which ECG change stays with the patient for life?

Accepted Answer

Q wave deepening is a permanent change seen on ECG following a transmural myocardial infarction, as it indicates irreversible damage to the myocardium. ST segment elevation and depression and P wave inversion may resolve or fluctuate depending on the patient's condition and treatment.

Question 4

Fifteen hours after admission, a patient's CPK-MB level is markedly increased. What does this indicate to the treatment team?

Accepted Answer

An increase in CPK-MB level indicates cellular necrosis of myocardial tissue, which suggests acute myocardial infarction (AMI) or heart attack. This information is crucial to the treatment team, as it guides the appropriate management of the patient's condition, such as administering thrombolytic therapy or other interventions. Lactic acid levels may also be elevated in AMI, but it is not the primary indicator. Cardiac function returning to normal would be a positive development, but an increase in CPK-MB would not be associated with this.

Question 5

The nurse, assessing a middle-aged patient experiencing chest pain, realizes that presence of which symptoms would be most characteristic of an acute myocardial infarction?

Accepted Answer

Substernal pressure type pain, radiating down the left arm is a classic symptom of an acute myocardial infarction. The other options are not as specific to a heart attack.

Question 6

Nursing care of the patient after thrombolytic therapy focuses on the assessment of which finding that is the most common complication?

Accepted Answer

Bleeding is the most common complication of thrombolytic therapy. Therefore, nursing care should focus on monitoring for signs of bleeding, including vital signs, hematocrit, and assessing incision sites for bleeding or bruising. While other complications can occur after thrombolytic therapy, they are not as common as bleeding.

Question 7

The nurse, caring for a patient admitted with chest pain, realizes that which factor places the patient at the highest risk for heart disease?

Accepted Answer

Being overweight, especially with excess abdominal fat, is a major risk factor for heart disease. Family history and stress are also potential risk factors, but overweight and obesity have a higher association with heart disease. Socioeconomic status may impact access to healthcare and healthy lifestyle choices, but it is not itself an independent risk factor for heart disease. A sedentary job may also contribute to heart disease risk, but not as significantly as obesity.

Question 8

During patient teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease?

Accepted Answer

Elevated homocysteine levels have been associated with an increased risk for the development of coronary artery disease. The other laboratory values listed are not directly related to the risk for coronary artery disease.

Question 9

A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient includes which nursing actions? Select all that apply.  Select all that apply.

Accepted Answer

Morphine intravenously and oxygen are the emergent treatment plan for a patient complaining of chest pain that is radiating down the left arm. Aspirin 325 mg orally is also an appropriate treatment. Open heart surgery, heparin drip at 100 units per hour, and Foley catheter insertion are not appropriate treatments for this patient.

Question 10

The nurse is assessing a patient who is six hours postoperative from coronary artery bypass graft (CABG) surgery. The patient's heart rate is 120, blood pressure is 90/50, urine output is decreased, chest tube output is decreased, heart sounds are muffled, and peripheral pulses are diminished. What action should be taken by the nurse first?

Accepted Answer

The patient's symptoms suggest cardiac tamponade, a potentially life-threatening complication after CABG surgery. The nurse should notify the physician immediately to facilitate prompt intervention.

Question 11

During a follow-up appointment after a myocardial infarction, a patient states, "My friends tell me to add more garlic to my diet and start drinking red wine each evening." Which response by the nurse is best?

Accepted Answer

The nurse should direct the patient to discuss any changes to their diet or lifestyle with their healthcare provider, who can provide evidence-based recommendations and ensure they are safe and appropriate for the patient's individual health status and medical history.

Question 12

The nurse, caring for a patient recovering from an acute myocardial infarction, realizes that the final extent of cardiac damage is dependent upon which factor?

Accepted Answer

Reperfusion of the ischemic zone is the most critical factor in determining the final extent of cardiac damage. The sooner reperfusion occurs, the less damage to the heart muscle will occur. Ethnicity, gender, and development of heart block are not directly correlated with the extent of myocardial damage.

Question 13

Which diagnostic test would the nurse anticipate as priority for a patient admitted with chest pain to determine coronary heart disease status?

Accepted Answer

Coronary angiography is the priority diagnostic test for determining the status of coronary heart disease in a patient admitted with chest pain. It provides detailed images of the blood vessels in the heart, allowing for the identification of any blockages or abnormalities that could be causing the chest pain.

Question 14

The nurse, caring for a patient with myocardial damage, would expect which change on the ECG tracing?

Accepted Answer

Myocardial damage is associated with ST segment elevation on the ECG tracing. Loss of P waves and bradycardia may be seen in conditions such as atrial fibrillation or heart block. Widening of the QRS complex may indicate conduction abnormalities.

Question 15

Upon ascultating the chest of a 75-year-old patient who recently experienced a myocardial infarction (MI) the nurse hears an S₃ and lung crackles. Because of these findings, the nurse would assess for which other condition?

Accepted Answer

The presence of S₃ (S3 and S4 heart sounds) along with lung crackles in a patient who recently had an MI suggests the development of heart failure. Heart failure can occur as a result of an MI due to damage to the heart muscle, and the additional sounds indicate that the heart is having difficulty pumping blood effectively. Renal and liver failure may cause additional symptoms, but they are not specifically related to the cardiac and pulmonary findings in this patient. Extension of the MI would also not be the primary concern at this point, as the patient has already had an MI and is likely being treated for it.

Question 16

The nurse, discussing coronary heart disease risk factors with a group of factory employees, would include which option(s) as modifiable risk factors?  Select all that apply.

Accepted Answer

Of the options given, hypertension, diabetes mellitus, and obesity are all modifiable risk factors for coronary heart disease. Age and heredity are non-modifiable risk factors.

Question 17

During an office visit, a 55-year-old female patient asks why she has not been prescribed a daily dose of aspirin. Her 56-year-old husband has been advised by the physician to take a daily aspirin. What can the nurse explain is the most likely reason for this?

Accepted Answer

The benefit of aspirin in women under age 65 is not clear, as the risks of gastrointestinal bleeding and hemorrhagic stroke may outweigh potential benefits. The physician may have recommended aspirin for the husband due to different risk factors or medical history.

Question 18

The nurse is teaching a patient about coronary artery bypass surgery. Which statement, included in this teaching, is essential for the patient to understand?

Accepted Answer

It is important for the patient to understand that even after coronary artery bypass surgery, they must continue to reduce or modify their cardiac risk factors to prevent further damage and complications to their heart.

Question 19

A patient, recovering from coronary artery bypass graft (CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which of the following is the most appropriate response for the nurse to make?  Select all that apply.

Accepted Answer

A is correct because CABG surgery helps to relieve symptoms of coronary artery disease but does not cure the underlying disease. B is correct because continuing to modify cardiac risk factors, such as diet, exercise, and smoking cessation, is crucial in managing heart disease and preventing further complications.

Question 20

A patient reports chest pain, nausea, and vomiting off and on for the last 4 days, which the patient interpreted as the flu. Which laboratory tests will provide information about acute cardiac damage for this patient?

Accepted Answer

Troponin I and T are specific markers for acute cardiac damage and are commonly used to diagnose myocardial infarction. Red blood cells and platelets are not specific markers for cardiac damage, and CPK-MB may be elevated in other conditions such as skeletal muscle injury. Homocysteine is a marker for cardiovascular disease risk, but it is not specific for acute cardiac damage.

Quiz 30: Nursing Care of Patients with Coronary Heart Disease