Deck 6: Care of the Patient Experiencing Shock

Question 1

Which statement explaining the relationship of body weight to acute coronary syndrome (ACS) should the nurse include when presenting a healthy heart program to a community group?
1) Excessive weight will result in a decrease in low-density lipoproteins (LDL), which is linked to ACS.
2) Extra weight can lead to diabetes insipidus, which will increase the risk for ACS.
3) Losing as little as 5% of one's body weight will significantly lower the risk for ACS.
4) Obesity, a BMI of greater than 30, increases the risk for ACS.

Answer 1

4
Explanation: 1. Excessive weight will increase low-density lipoproteins.
2. Extra weight can lead to the development of diabetes mellitus.
3. A weight loss of 10% has been shown to improve risk for ACS.
4. Increased weight increases the risk for diabetes mellitus and decreased HDL, which are both risk factors for ACS.

Question 2

A patient says, "I've never heard of an acute coronary syndrome. Please explain what happened to me." What should the nurse explain about the health problem?
1) "It is another name for a myocardial infarction (MI) or heart attack."
2) "It is a group of disorders that result in insufficient oxygen supply to the heart."
3) "It is the second leading cause of death in the United States."
4) "It is a type of abnormal heart rhythm."

Answer 2

2
Explanation: 1. An MI/heart attack is only one of the disorders that falls under this group of disorders. An MI includes tissue necrosis from arterial obstruction.
2. Acute coronary syndrome (ACS) is an inclusive term for conditions that cause chest pain due to insufficient blood supply to the heart muscle.
3. ACS is the leading cause of death in the United States.
4. ACS is not a type of abnormal heart rhythm.

Question 3

What action would be most helpful to the nurse to determine if a patient's chest pain is cardiac in origin?
1) Gathering a complete medical history
2) Performing a 12-lead ECG
3) Administering NTG to see if the pain goes away
4) Asking the patient if performing a Valsalva maneuver reduces the pain

Answer 3

2
Explanation: 1. Reviewing a complete history will waste time in what might be an emergent situation.
2. A 12-lead ECG is performed immediately if the symptoms suggest that pain is cardiac in origin.
3. Just experimenting with a drug such as NTG should not be the first choice for differentiating the source of the chest pain. Also, it is unsafe to give a drug without a specific reason or cause.
4. Performing the Valsalva maneuver will increase abdominal and thoracic pressures and can cause vagal stimulation that will result in decreased heart rate. It should not be suggested unless tachycardia is present and emergency equipment is available in case of cardiac arrest. This is not a method of differentiating the types of chest pain.

Question 4

A nurse is preparing to administer the first 5 mg dose of metoprolol (Toprol) to a patient who is 12 hours post MI. For which assessment finding should the nurse withhold administration of the medication?
1) Serum potassium 3.9 mEq/L
2) Blood pressure of 110/65 mm Hg
3) PR interval 0.12 second
4) Sinus bradycardia 52 beats per minute

Question 5

What should be included in the collaborative management of a patient's pulmonary status following coronary artery bypass graft surgery?
1) Keeping the patient intubated for at least 48 hours to maximize gas exchange
2) Mobilizing the patient as soon as possible to prevent atelectasis and venous stasis
3) Evaluating readiness for extubation based on guidelines: PO₂ less than 80 mm Hg with an FiO₂ greater than 40% and a PCO₂ greater than 45
4) Extubating when the patient is arousable to noxious stimuli and shows increased effort for spontaneous breathing

Question 6

The nurse instructs a patient with a myocardial infarction about the disease process. Which patient statement indicates that additional teaching is needed?
1) "A heart attack is the same as a myocardial infarction (MI)."
2) "A heart attack causes tissue death, and that part of the heart may not pump as well."
3) "A heart attack in the anterior wall of the heart can be very serious because a large portion of the heart may not pump as well."
4) "Angina always leads first to decreased blood flow to the heart muscle and then to tissue death."

Question 7

Following angioplasty, a patient develops hematuria, hypotension, tachycardia, a drop in hemoglobin and hematocrit, and a decrease in oxygen saturation. What is most likely the cause for these symptoms?
1) Reaction to vasovagal stimulation
2) Myocardial ischemia
3) Peripheral emboli distal to the insertion site
4) Over-anticoagulation

Question 8

Which laboratory value should the nurse review to validate a diagnosis of a myocardial infarction (MI) that was suspected of occurring approximately 3 hours earlier?
1) CK
2) Troponin T assay
3) Myoglobin
4) PTT

Question 9

The multidisciplinary team should identify which goals for initial collaborative management of a patient with an acute coronary event (ACS)? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Limit the size of infarction by decreasing oxygen demands.
2) Maximize coronary artery blood flow.
3) Strengthen the heart by increasing activity as soon as possible.
4) Balance oxygen demand with supply.
5) Prevent dysrhythmias with prophylactic antidysrhythmic medications.

Question 10

The nurse is teaching a patient about acute coronary syndrome. What should the nurse teach that describes the progression of events in this disorder?
1) A thin fibrin layer stabilizes the ruptured plaque and prevents the occlusion of coronary vessels when stable angina is present in ACS.
2) When complete platelet occlusion occurs in a vessel, the ECG changes include nonspecific ST elevation without necrosis occurring in ACS.
3) The growth of platelet-rich thrombi in the smaller vessels creates a blockage and is the cause for unstable angina symptoms in ACS.
4) Sudden plaque buildup in a narrow vessel immediately leads to an acute myocardial infarction when stable angina is present in ACS.

Question 11

Which factors would contribute to the risk of a patient developing stress ulcers after coronary artery bypass graft (CABG) surgery? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Incidence of postoperative hemorrhaging
2) Age less than 70 years
3) Alcohol abuse or excess
4) Need for vasodilators for postoperative hypertension
5) Prolonged use of cardiopulmonary bypass

Question 12

A nurse is caring for a patient who has just started to bleed from the insertion site following a cardiac catheterization. What should be the nurse's first response?
1) Administer vitamin K (AquaMEPHYTON).
2) Locate and apply a compression clamp.
3) Apply a collagen patch or sheath.
4) Apply manual pressure to the site.

Question 13

A patient says, "The chest pain occurs each time I play basketball; it does not occur when I am sleeping; and it improves when I take those pills under my tongue." What health problem is this patient describing?
1) Variant or Prinzmetal's angina
2) Undifferentiated angina
3) Unstable angina
4) Stable angina

Question 14

To increase compliance and reduce postoperative complications, the nurse should include which topics in the preoperative teaching for a patient who is to have a coronary artery bypass graft (CABG)? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Reasons for cooling blankets in postop period
2) Equipment used: IVs, Foley, pacer wires, chest tubes, NG tubes, ECG leads
3) Alternate methods for communicating when intubated
4) Reasons and techniques of turning, coughing, and deep breathing once extubated
5) Drug management: need for sedation when intubated, pain med through PCA

Question 15

Which finding should cause the nurse to suspect that a patient recovering from coronary artery bypass surgery might be developing cardiac tamponade? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Widening pulse pressure
2) Increased jugular vein distension
3) Decreasing central venous pressure (CVP)
4) Muffled heart sounds
5) Lack of pleural (chest) tube drainage

Question 16

A nurse is discussing management of hypertension with a patient. Which patient statement indicates that additional teaching about the relationship between hypertension and acute coronary syndrome (ACS) is needed?
1) "My high blood pressure has no relationship to the severity of heart disease or its outcomes."
2) "Because I'm over 80, even a 20 mm Hg drop in my blood pressure can reduce my risk."
3) "High blood pressure will increase my body's need for oxygen and increase my heart's workload."
4) "Controlling my blood pressure will decrease my risk of having a heart attack to some degree."

Question 17

A patient is admitted with chest discomfort and a possible USA/NSTEMI. What would be a contraindication to administration of GP-IIb-IIIA inhibitors to the patient?
1) Major surgery in the last 6 months
2) A creatinine level of 1.4 mg/dL
3) A stroke within the past month
4) A platelet count greater than 150,000 mm³

Question 18

The electrocardiogram of a patient receiving tPA for a myocardial infarction shows that the ST segment has returned to baseline. How should the nurse interpret this finding?
1) The spasm in the coronary artery has resolved.
2) The myocardial injury is evolving.
3) The patient has become more relaxed.
4) The blocked artery has been reperfused.

Question 19

A patient tells a nurse, "My chest pain starts when I am resting, and when I had a cardiac catheterization, the doctor said I was having vasospasms." Which type of medication should the nurse anticipate to be prescribed to treat the patient's angina?
1) A vasodilator, such as nitroglycerin (NTG)
2) A calcium channel blocking agent
3) An antidysrhythmic, such as lidocaine
4) A beta adrenergic blocking agent

Question 20

An 80-year-old woman is being assessed for a myocardial infarction. Which symptoms would more likely occur in this patient because of the patient's gender and age?
1) Jaw and/or tooth pain
2) Centralized chest pain
3) Generalized fatigue accompanied by dyspnea and diaphoresis
4) Dyspnea accompanied by crackles in all lobes

Question 21

The nurse is discussing the Dietary Approaches to Stop Hypertension (DASH) program with a patient and spouse. They are overwhelmed and ask if there is one measure recommended by the program that would have the biggest impact so they can start with that measure first. What should the nurse suggest?
1) Decreasing sodium intake to less than 1,500 mg/day
2) Losing weight
3) Increasing intake of dairy products
4) Controlling diabetes to an A_1C less than 7%

Question 22

The nurse begins emergency care of a patient with a myocardial infarction. Place in order the medication interventions that the nurse will provide to this patient.

A) Administer four baby-strength aspirins.
B) Administer nitroglycerin.
C) Apply oxygen.
D) Administer morphine 2 to 5 mg intravenous every 5 to 30 minutes as needed.
E) Administer a beta blocker.
F) None of the above

Question 23

The nurse prepares material highlighting the impact of activity and exercise on preventing heart disease for a group of community members. What other risk factors for heart disease should the nurse emphasize that are positively impacted by exercise? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Obesity
2) Arthritis
3) Diabetes
4) Hypertension
5) Hyperlipidemia

Question 24

A patient with type 2 diabetes mellitus is prescribed nicotinic acid (Nicobid) as adjunctive therapy for hypercholesterolemia. What should the nurse instruct the patient about this medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Instruct to check blood glucose level frequently for elevations.
2) Teach that this medication may cause the patient to feel warm.
3) Instruct the patient that a flushed face can occur within 2 hours after taking.
4) Teach to not take medication with grapefruit juice.
5) Remind to notify the health care provider of any onset of muscle pain.

Question 25

Which is least likely to be a goal of a patient participating in cardiac rehabilitation?
1) Taking control of his life through healthy choices
2) Managing symptoms by monitoring exercise
3) Reducing risks by controlling the modifiable risk factors
4) Stabilizing any severe depression that developed post-MI

Question 26

The nurse cares for a patient recovering from coronary artery bypass grafting (CABG) surgery. Which action should the nurse take to maximize this patient's renal function? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Monitor urine output hourly for 24 hours.
2) Evaluate postoperative serum potassium level.
3) Transition to subcutaneous insulin sliding scale.
4) Keep nasogastric tube to low continuous suction.
5) Request orders for blood urea nitrogen and creatinine levels.

Question 27

A patient being discharged after an MI is prescribed lisinopril (Prinivil) 10 mg daily. Which instruction is most appropriate for the nurse to give to the patient?
1) Avoid crossing your legs.
2) Weigh yourself at least 3 times a week.
3) Cut down on your sodium intake to 1,500 mg/day.
4) Change your position slowly when going from lying to sitting.

Question 28

The nurse reviews orders written for a patient with non-ST-segment elevation myocardial infarction (NSTEMI). Which order should the nurse question before implementing?
1) Bedrest for 48 hours
2) Supplemental oxygen
3) Antiemetic as needed
4) Serial cardiac enzymes

Question 29

The nurse instructs a patient about acute coronary syndrome. What should be included in these instructions? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Fatty plaques develop in the coronary arteries.
2) Plaques in arteries limit the amount of blood that can flow through the heart vessels.
3) Plaque in coronary arteries can cause stable angina.
4) If a plaque ruptures, it can get into the general circulation.
5) Stable angina rarely progresses to unstable angina.

Question 30

A patient with chest pain is prescribed to have a troponin level drawn. What is the purpose of this diagnostic test when caring for a patient with chest pain? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) It appears in the bloodstream 4 to 12 hours after the onset of cardiac injury.
2) The peak level of troponin appears in 12 hours.
3) If a cardiac injury has occurred, the troponin level will stay elevated for 7 to 10 days.
4) The troponin level may be a predictor of myocardial infarction size.
5) A negative result does not need to be retested.

Question 31

A patient recovering from coronary artery bypass grafting is experiencing dysrhythmias. What should the nurse assess as a reason for the dysrhythmias? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Patient's body temperature
2) Potassium level
3) Calcium level
4) Arterial blood gases
5) Pupil size and reactivity to light

Question 32

The nurse prepares discharge instructions for a patient recovering from percutaneous transluminal coronary intervention (PTCI). What medication information should the nurse include with this teaching? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Aspirin
2) Heparin
3) Ibuprofen
4) Clopidogrel
5) Acetaminophen

Question 33

During a health history, the nurse suspects a patient has been experiencing stable angina. What did the patient most likely describe to the nurse? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Chest pain that lasts between 5 and 10 minutes
2) Chest pain that occurs during stress
3) Chest pain that occurs when outside on very cold days
4) Chest pain that stops with rest
5) Chest pain that occurs at rest

Question 34

The nurse teaches a patient with coronary artery disease about prescribed nitroglycerin therapy. Which patient statement indicates further teaching is needed?
1) "If the pain doesn't go away, I can take a second tablet after 5 minutes."
2) "I should not take nitroglycerin if I have taken Viagra."
3) "I should try to sit or lie down when I take the nitroglycerin."
4) "I'll put a couple of tablets in a plastic bag in my pocket so I have them with me all the time."

Question 35

What intervention should the nurse include when planning care for a patient recovering from PCI with stent placement? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Monitor for reperfusion dysrhythmias.
2) Monitor for bleeding from the catheter site.
3) Assess for pulses at the ankle and knee.
4) Maintain the patient on bedrest with the cannulated extremity straight for 4 to 6 hours.
5) Administer blood products for low blood pressure as prescribed.

Question 36

The nurse instructs a patient on the procedure for percutaneous transluminal coronary intervention (PCTI) with stent placement. Which patient statement indicates that teaching has been effective? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "This procedure is done on an artery that is about 70% smaller than it should be."
2) "The artery in my heart is reached by going through an artery in my leg."
3) "After the fatty clot is smashed against the artery wall, a mesh stent remains in the artery to keep it open."
4) "I will need to take aspirin and another blood thinner for up to 6 months after the procedure."
5) "I will have my blood sugar level measured many times after the procedure."