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

Question 1

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

A) Heparin will dissolve the clot that is blocking blood flow to the heart.
B) Coronary artery plaque size and adherence are decreased with heparin.
C) Heparin will prevent the development of clots in the coronary arteries.
D) Platelet aggregation is enhanced by IV heparin infusion.

Answer 1

Heparin will prevent the development of clots in the coronary arteries.

Question 2

Which electrocardiographic (ECG) change will be of most concern to the nurse when admitting a patient with chest pain?

A) Sinus tachycardia
B) Inverted T wave
C) ST-segment elevation
D) Frequent PACs

Answer 2

ST-segment elevation

Question 3

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?

A) "Atenolol will increase the strength of my heart muscle."
B) "I can expect to feel short of breath when taking atenolol."
C) "Atenolol will improve the blood flow to my coronary arteries."
D) "It is important not to suddenly stop taking the atenolol."

Answer 3

"It is important not to suddenly stop taking the atenolol."

Question 4

A patient is admitted to the ED after an episode of severe chest pain, and the physician schedules the patient for coronary angiography and possible percutaneous coronary intervention (PCI). The nurse prepares the patient for the procedure by explaining that it is used to

A) determine whether there are any structural defects in the chambers of the heart.
B) locate any coronary artery obstructions and administer thrombolytic agents.
C) measure the amount of blood being pumped from the heart with each contraction.
D) visualize any coronary artery blockages and dilate any obstructed arteries.

Question 5

A patient with chronic stable angina is being treated with metoprolol (Lopressor). The nurse will suspect that the patient is experiencing a side effect of the metoprolol if

A) the patient is restless and agitated.
B) the BP is 190/110 mm Hg.
C) the cardiac monitor shows a heart rate of 45.
D) the patient complains about feeling anxious.

Question 6

Following an 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?

A) BP rises from 118/60 to 126/68 mm Hg.
B) Respiratory rate goes from 14 to 22 breaths/min.
C) Oxygen saturation drops from 100% to 98%.
D) Heart rate increases from 66 to 90 beats/min.

Question 7

The nurse administers IV nitroglycerin to a patient with an MI. In evaluating the effect of this intervention, the nurse should monitor for

A) relief of chest discomfort.
B) a decreased heart rate.
C) an increase in BP.
D) fewer cardiac dysrhythmias.

Question 8

In developing a teaching plan for a patient who has stable angina and is started on sublingual nitroglycerin (Nitrostat), the nurse identifies an expected patient outcome of

A) stating that nitroglycerin is to be taken only if chest pain develops.
B) listing the side effects of nitroglycerin as gastric upset and dry mouth.
C) identifying the need to call the emergency medical services (EMS) if chest pain persists 5 minutes after taking nitroglycerin.
D) recognizes that taking the nitroglycerin is important to decrease the ongoing atherosclerosis of the coronary arteries.

Question 9

When caring for a patient with ACS who has returned to the coronary care unit after having a PCI, the nurse obtains these assessment data. Which data indicate the need for immediate intervention by the nurse?

A) Heart rate 100 beats/min
B) Chest pain level 8 on a 10-point scale
C) Blood pressure (BP) 104/56 mm Hg
D) Pedal pulses 2+

Question 10

A patient admitted to the coronary care unit (CCU) with an MI and frequent premature ventricular contractions (PVCs) has health care provider orders for continuous amiodarone infusion, IV nitroglycerin infusion, and morphine sulfate 2 mg IV every 10 minutes until there is relief of pain. The patient says, "This is the worst pain I have ever had. Am I going to die?" Based on these data, the nurse identifies a priority nursing diagnosis of

A) acute pain related to myocardial ischemia.
B) anxiety related to perceived threat of death.
C) decreased cardiac output related to cardiogenic shock.
D) activity intolerance related to decreased cardiac output.

Question 11

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

A) help to prevent clotting in the coronary arteries.
B) decrease spasm of the coronary arteries.
C) increase the force of myocardial contraction.
D) reduce the "fight or flight" response.

Question 12

Nadolol (Corgard) is prescribed for a patient with angina. In evaluating the effectiveness of the drug, the nurse will monitor for

A) improvement in the quality of the peripheral pulses.
B) ability to do daily activities without chest discomfort.
C) decreased BP and apical pulse rate.
D) fewer complaints of having cold hands and feet.

Question 13

The nurse is admitting a patient who is complaining of chest pain to the emergency department (ED). Which information collected by the nurse suggests that the pain is caused by an acute myocardial infarction (AMI)?

A) The pain worsens when the patient raises the arms.
B) The pain increases with deep breathing.
C) The pain is relieved after the patient takes nitroglycerin.
D) The pain has persisted longer than 30 minutes.

Question 14

To assist the patient with CAD to make the appropriate dietary changes, which of these nursing interventions will be most effective?

A) Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible.
B) Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.
C) Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary.
D) Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes.

Question 15

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis?

A) The patient rates the pain at a level 3 to 5 (0-10 scale).
B) The patient states that the pain "wakes me up at night."
C) The patient indicates that the pain is resolved after taking one sublingual nitroglycerin tablet.
D) The patient says that the frequency of the pain has increased over the last few weeks.

Question 16

Which of these statements made by a patient after the nurse has completed teaching about the TLC diet indicates that further teaching is needed?

A) "I will switch from whole milk to 1% or nonfat milk."
B) "I like fresh salmon and I will plan to eat it more often."
C) "I will miss being able to eat peanut butter sandwiches."
D) "I can have a cup of coffee with breakfast if I want one."

Question 17

When developing a health teaching plan for a 65-year-old patient with all these risk factors for coronary artery disease (CAD), the nurse will focus on the

A) family history of heart disease.
B) increased risk associated with the patient's ethnicity.
C) high incidence of cardiovascular disease in older people.
D) low activity level the patient reports.

Question 18

A patient who has had severe chest pain for the last 4 hours is admitted with a diagnosis of possible AMI. Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an MI?

A) Troponin levels
B) C-reactive protein
C) High-density lipoprotein (HDL) cholesterol
D) Homocysteine

Question 19

A patient with ST-segment elevation in several ECG leads is admitted to the ED and diagnosed as having an AMI. Which question should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy?

A) "Is there any family history of heart disease?"
B) "Do you take aspirin on a daily basis?"
C) "Can you describe the quality of your chest pain?"
D) "What time did your chest pain begin?"

Question 20

While admitting a patient with an AMI, which action should the nurse carry out first?

A) Assess peripheral pulses.
B) Check the oxygen saturation.
C) Attach the cardiac monitor.
D) Obtain the BP.

Question 21

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?

A) Administration of the ordered metoprolol (Lopressor) and aspirin
B) Evaluating the patient's response to ambulation in the hallway
C) Teaching the patient about the pathophysiology of heart disease
D) Completing the documentation for a home health nurse referral

Question 22

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

A) "Sexual intercourse may be too strenuous on your heart, but closeness and intimacy can be maintained with holding and cuddling."
B) "You should discuss your questions about your sexual activity with your doctor because the activity it requires is a medical concern."
C) "Sexual activity can be resumed whenever you feel like you are ready. Most sexual response is emotional rather than physical."
D) "Sexual activity can be gradually resumed like other activity. A good comparison of energy expenditure is climbing two flights of stairs."

Question 23

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

A) A 38-year-old who has pericarditis and is complaining of sharp, stabbing chest pain
B) A 45-year-old who had an MI 4 days ago and is anxious about the planned discharge
C) A 51-year-old who has just returned to the unit after a coronary arteriogram and PCI
D) A 60-year-old who has a scheduled dose of atenolol (Tenormin) 25 mg PO due

Question 24

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,

A) "I will need to take an aspirin a day after the surgery to keep the graft open."
B) "I will have incisions in my leg where they will remove the vein."
C) "They will stop my heart and circulate my blood with a machine during the surgery."
D) "They will use an artery near my heart to bypass the area that is obstructed."

Question 25

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?

A) Have the family members encourage the patient to continue planning for the vacation.
B) Allow the use of denial as a coping mechanism until the patient begins asking questions about the MI.
C) Implement reality orientation by reminding the patient several times a day about the MI.
D) Begin teaching the patient about the normal functions of the heart to improve understanding of the MI.

Question 26

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

A) No change in the patient's chest pain
B) A large bruise at the patient's IV insertion site
C) A decrease in ST-segment elevation on the ECG
D) An increase in cardiac enzyme levels since admission

Question 27

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

A) splitting of the S₁ heart sound.
B) S₃ or S₄ gallop rhythm.
C) pericardial friction rub.
D) holosystolic apical murmur.

Question 28

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?

A) The oral temperature is 100.8° F (38.2° C).
B) The white blood cell count (WBC) is 12,000/ml.
C) The patient denies ever having a heart attack.
D) The lungs have crackles audible to the midline.

Question 29

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

A) that sudden cardiac death events rarely reoccur.
B) about the purpose of outpatient Holter monitoring.
C) how to self-administer low-molecular-weight heparin.
D) to limit activities after discharge to prevent future events.

Question 30

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?

A) "I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin."
B) "I will put on the nitroglycerin patch as soon as I develop any chest pain."
C) "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
D) "I will keep the nitroglycerin in my kitchen window where I can find it quickly."

Question 31

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

A) bleeding from the gums.
B) surface bleeding from the IV site.
C) a decrease in level of consciousness.
D) a nonsustained episode of ventricular tachycardia.

Question 32

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

A) the pathophysiology of coronary artery disease.
B) when patient cardiac rehabilitation will begin.
C) home-discharge drugs such as aspirin and b-blockers.
D) typical emotional responses to MI.

Question 33

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?

A) Chest x-ray
B) Troponin level
C) CT scan
D) ECG

Question 34

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?

A) Skin flushing after taking the medications
B) Dizziness when changing positions quickly
C) Nausea when taking the drugs before eating
D) Generalized muscle aches and pains

Question 35

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

A) ineffective coping related to depression and anxiety.
B) situational low self-esteem related to perceived role changes.
C) impaired adjustment related to unwillingness to alter lifestyle.
D) ineffective health maintenance related to lack of knowledge.

Question 36

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?

A) Have the patient take this medication with an aspirin.
B) Encourage the patient to take it with a sip of water.
C) Give the patient's other medications 2 hours after the Welchol.
D) Administer the drug at the patient's bedtime.

Question 37

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?

A) captopril (Capoten)
B) furosemide (Lasix)
C) sildenafil (Viagra)
D) diazepam (Valium)