Deck 40: Care of Patients With Acute Coronary Syndromes

Question 1

While evaluating a client's electrocardiogram (ECG)before surgery,the preoperative nurse identifies large,wide Q waves.What is the nurse's best interpretation of this finding?

A) An acute myocardial infarction is occurring.
B) The client had a myocardial infarction in the past.
C) The ventricles are enlarged and failing.
D) The ECG is a common variation of normal sinus rhythm.

Answer 1

The client had a myocardial infarction in the past.

Question 2

A client who is post percutaneous transluminal coronary angioplasty (PTCA)reports severe chest pain.Which action does the nurse take first?

A) Administer the prescribed IV morphine.
B) Administer the prescribed sublingual nitroglycerin.
C) Assess the client's vital signs and notify the health care provider.
D) Perform an immediate 12-lead ECG.

Answer 2

Assess the client's vital signs and notify the health care provider.

Question 3

The community health nurse assesses clients at a health fair.Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease?

A) "Would you please state your full name and birth date?"
B) "Have you ever had an exercise tolerance stress test?"
C) "In what activities do you participate on a daily basis?"
D) "Does anyone in your family have a history of heart disease?"

Answer 3

"In what activities do you participate on a daily basis?"

Question 4

The emergency department nurse is assessing an 82-year-old client for a potential myocardial infarction.Which clinical manifestation does the nurse monitor for?

A) Pain on inspiration
B) Posterior wall chest pain
C) Disorientation or confusion
D) Numbness and tingling of the arm

Question 5

The nurse is assisting a client to walk in the hall on the third day after a myocardial infarction.Which clinical manifestation indicates to the nurse that the client is not ready to advance to the next level of activity?

A) Facial flushing
B) Onset of chest pain
C) Heart rate increase of 10 beats/min at completion of the activity
D) Systolic blood pressure increase of 10 mm Hg at completion of the activity

Question 6

A client who presented with an acute myocardial infarction is prescribed thrombolytic therapy.The client had a stroke 1 month ago.Which action does the nurse take?

A) Administer the medication as prescribed.
B) Perform a CT scan before administering the medication.
C) Contact the health care provider to discontinue the prescribed therapy.
D) Administer the therapy with a normal saline bolus.

Question 7

The nurse is providing care for a client admitted to the hospital with reports of chest pain.After receiving a total of three nitroglycerin sublingual tablets,the client states,"The pain has not gotten any better." What does the nurse do next?

A) Place the client in a semi-Fowler's position.
B) Administer intravenous nitroglycerin.
C) Begin supplemental oxygen at 2 L/min.
D) Notify the health care provider.

Question 8

The nurse is administering thrombolytic therapy to a client who had a myocardial infarction.Which intervention does the nurse implement to reduce the risk of complications in this client?

A) Administer prescribed heparin.
B) Apply ice to the injection site.
C) Place the client in Trendelenburg position.
D) Instruct the client to take slow deep breaths.

Question 9

The nurse is assessing a client who has a history of stable angina.The client describes a recent increase in the number of attacks and in the intensity of the pain.Which question does the nurse ask to assess the client's change in condition?

A) "How many cigarettes do you smoke daily?"
B) "Do you have pain when you are resting?"
C) "Do you have abdominal pain or nausea?"
D) "How frequently are you having chest pain?"

Question 10

The nurse is teaching a client who is prescribed a calcium channel blocking agent after a percutaneous transluminal coronary angioplasty (PTCA).Which instruction does the nurse include in this client's teaching?

A) "Change position slowly."
B) "Avoid crossing your legs."
C) "Weigh yourself daily."
D) "Decrease salt intake."

Question 11

The nurse assesses a client who has received thrombolytic therapy after having a myocardial infarction.Which clinical manifestation indicates to the nurse that reperfusion has been successful?

A) ST-segment depression
B) Cessation of diaphoresis
C) Sudden onset of pleuritic chest pain
D) Onset of ventricular dysrhythmias

Question 12

The nurse is teaching a client prescribed sublingual nitroglycerin for chest pain.Which statement indicates that the client needs further teaching?

A) "I carry my medicine around in a clear plastic bag so that I can get to it easily if I have chest pain."
B) "Even if I have not used any of the nitroglycerin from one refill, I get another refill every 3 months."
C) "If I still have chest pain after I have taken 3 nitroglycerin tablets, I will go to the hospital."
D) "When my nitroglycerin tablet tingles under my tongue, I know that it is strong enough to work."

Question 13

The nurse is caring for a client who had a myocardial infarction.The client develops increased pulmonary congestion; an increase in heart rate from 80 to 102 beats/min; and cold,clammy skin.Which action does the nurse implement before notifying the health care provider?

A) Administer oxygen.
B) Increase the IV flow rate.
C) Place the client in supine position.
D) Prepare the client for surgery.

Question 14

The nurse teaches a client who is newly diagnosed with coronary artery disease.Which instruction does the nurse include to minimize complications of this disease?

A) "Rest is the best medicine at this time. Do not start an exercise program."
B) "You are a man; therefore there is nothing you can do to minimize your risks."
C) "You should talk to your provider about medications to help you quit smoking."
D) "Decreasing the carbohydrates in your diet will help you lose weight."

Question 15

The nurse evaluates diagnostic results for a client who has chest pain.Which laboratory test is most specific for acute coronary syndromes?

A) Troponin markers
B) Serum lactate dehydrogenase (LDH)
C) Serum myoglobin
D) Creatine kinase (CK)-MB isoenzyme

Question 16

Eight hours after presentation to the emergency department with reports of substernal chest pain,a client's laboratory results demonstrate myoglobin levels of 55 ng/mL.What does the nurse do next?

A) Prepare the client for an emergency coronary bypass graft surgery.
B) Administer nitroglycerin to prevent further myocardial cell death.
C) Assess the client to identify another potential cause of the chest pain.
D) Provide client education related to complications of myocardial infarctions.

Question 17

The nurse is assessing a client who had percutaneous transluminal coronary angioplasty (PTCA)1 hour ago.Which complication does the nurse monitor for?

A) Hypertensive crisis
B) Hyperkalemia
C) Infection
D) Bleeding

Question 18

The nurse is assessing a client who has been prescribed a nonselective beta-blocking agent.Which adverse effect does the nurse monitor for in this client?

A) Headache
B) Postural hypotension
C) Nonproductive cough
D) Wheezing

Question 19

The nurse is assessing a client who has left ventricular failure secondary to a myocardial infarction.Which clinical manifestation of poor organ perfusion does the nurse monitor for in this client?

A) Headache
B) Hypertension
C) Urine output of less than 30 mL/hr
D) Heart rate of 55 to 60 beats/min

Question 20

The nurse is taking the history of a client with suspected coronary artery disease (CAD).Which situation correlates with stable angina?

A) Chest discomfort at rest and inability to tolerate mowing the lawn
B) Chest discomfort when mowing the lawn and subsiding with rest
C) Indigestion and a choking sensation when mowing the lawn
D) Jaw pain that radiates to the shoulder after mowing the lawn

Question 21

The nurse administers intravenous dobutamine (Dobutrex)to a client who has heart failure.Which clinical manifestations indicate that the client's status is improving?

A) Decreased heart rate
B) Increased heart rate
C) Increased contractility
D) Decreased contractility
E) Increased respiratory rate

Question 22

The nurse is assessing a client who has a serum potassium level of 4.5 mEq/L after coronary artery bypass graft (CABG)surgery.Which action does the nurse take?

A) Notify the health care provider.
B) Document the finding.
C) Administer prescribed diuretics.
D) Administer prescribed potassium replacements.

Question 23

The nurse is caring for an 80-year-old client who has had coronary artery bypass graft surgery.Which assessment does the nurse prioritize for this client?

A) Skin
B) Otoscopic
C) Mental status
D) Gastrointestinal

Question 24

A client is hospitalized after a myocardial infarction.Which hemodynamic parameters does the nurse correlate with cardiogenic shock?

A) Decreased cardiac output
B) Increased cardiac output
C) Increased mean arterial pressure (MAP)
D) Decreased MAP
E) Increased afterload
F) Decreased afterload

Question 25

The nurse is assessing a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA)and is ordered to receive an IV infusion of abciximab (ReoPro).Which clinical manifestation does the nurse monitor for in this client?

A) Bleeding
B) Joint pain
C) Pedal edema
D) Excessive thirst

Question 26

The nurse is planning a community health promotion program for cardiovascular disease.Which risk factors of coronary artery disease (CAD)does the nurse include in the education?

A) Cigarette smoking
B) Use of alcohol
C) Insomnia
D) Hypertension
E) Obesity
F) Depression

Question 27

The nurse is monitoring the electrocardiogram (ECG)of a client who has a myocardial infarction.Which changes does the nurse expect to see in the ECG tracing?

A) ST-segment depression
B) T-wave inversion
C) Normal Q waves
D) ST-segment elevation
E) T-wave elevation
F) Abnormal Q wave

Question 28

The nurse is assessing a client who is 6 hours postoperative from coronary artery bypass graft surgery.The client's mediastinal tubes are not draining.Which action does the nurse implement at this time?

A) Replace the drainage tubing.
B) Check for kinks in the tubing.
C) Irrigate the tubing with normal saline.
D) Document the finding.

Question 29

The nurse is planning discharge education for a client after coronary artery bypass graft surgery.Which instruction does the nurse include in this client's teaching?

A) "Remember to drink at least 3 liters of fluid daily."
B) "You should abstain from sexual activity for 6 months."
C) "Take your pulse before, midway through, and after exercising."
D) "Stop taking your antihyperlipidemic medication at this time."