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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

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?

Accepted Answer

1. The medication would not need to be withheld for this laboratory value.
2. The medication can be given with this blood pressure.
3. This medication can be given with this PR interval.
4. Beta blocker therapy is contraindicated when the patient has a heart rate less than 60 beats per minute, systolic blood pressure less than 100 mm Hg, moderate or severe left ventricular failure, shock, PR interval on the electrocardiogram greater than 0.24 second, second- and third-degree heart block, and active asthma and/or reactive airway disease.

Question 5

What should be included in the collaborative management of a patient's pulmonary status following coronary artery bypass graft surgery?

Accepted Answer

1. No set timing is required for extubation "readiness" is needed. Usually the patient is on the ventilator for less than 24 hours to minimize ventilator-related problems and to maximize O₂ exchange during the first 24 hours after surgery. 2. Pulmonary functions decline with immobility. Gravitational pull on secretions to posterior areas and inadequate inflation cause atelectasis. Activity and position changes will increase mobility of secretions. Even if the patient is intubated, extra movement by changing of positions will minimize respiratory complications or congestion in the lungs, both of which will increase the work effort of the heart and decrease perfusion and ventilation if not corrected. 3. The goal settings for adequate ventilation are: O₂ greater than 80 mm Hg, FiO₂ less than 40%, and PCO₂ less than 45. 4. Weaning the patient off the intubation process needs to be done gradually and based on blood gas values, pH, O₂ saturations, respiratory effort, fatigue, and coloring. This will allow for maximum gas exchange with the least O₂ demand when "readiness" has been achieved. With increased respiratory effort, more O₂ is required due to increased muscle efforts-the reasoning for gradually weaning based on each patient's response.

Question 6

The nurse instructs a patient with a myocardial infarction about the disease process. Which patient statement indicates that additional teaching is needed?

Accepted Answer

1. This is correct information. No clarification is needed by the nurse.
2. This is correct information. No clarification is needed by the nurse.
3. This is correct information. No clarification is needed by the nurse.
4. Angina pectoris is the pain from ischemia, but necrosis of myocardial tissue does not occur with each episode of pain. The pain is from tissue hypoxia; ischemia areas may improve or deteriorate into necrosis due to collateral circulation from other vessels.

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?

Accepted Answer

1. Vasovagal symptoms would include decreasing heart rate and not impact the H/H or O₂ saturation levels. Blood pressure may be down, and fainting usually occurs with orthostatic positioning. 2. Ischemia may cause BP and HR symptoms with changes in O₂ saturation but not the decline in H/H. 3. Emboli distal to the insertion site will not alter the BP, HR, H/H, or O₂saturation. The pulses will be diminished or absent depending on the degree of obstruction or the size of thrombi. 4. The symptoms are a result of over-anticoagulation, which results in blood loss through the kidneys and other organs, resulting in a declining hemoglobin/hematocrit (H/H). The decrease of RBCs results in the compensation mechanism for shock by increasing the HR when compensating for the tissue hypoxia present from the lack of RBCs. Decreased perfusion and O₂ saturation in the tissues will be present.

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?

Accepted Answer

1. Creatinine phosphokinase (CK) serum levels peak between 12 and 14 hours and return to normal after 72 to 96 hours. Therefore, it would not help during the first few hours to validate an MI.
2. Troponin T assay is the most sensitive for cardiac damage but does not appear in the bloodstream until 4 to 12 hours after the damage occurs. It returns to normal after 4 to 10 days.
3. Myoglobin will peak between 1 and 4 hours after the hypoxic/necrotic event and return to normal in 24 hours. Therefore, it is the first to rise when tissue damage has occurred.
4. PTT does not measure tissue damage; it measures serum clotting times for anticoagulant therapy. Therefore, it would not validate when or if an MI occurred.

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.

Accepted Answer

1. The symptoms are caused by decreased oxygen or increased demand for oxygen in the myocardium. If the nurse increases the oxygen supply and decreases the level of activity (decreasing metabolic rates) to decrease the demands, ischemic tissue can recover or limit additional tissue death. Prolonged continually, hypoxia will eventually cause tissue necrosis (death). 2. In a collaborative environment, maximization of coronary artery blood flow would be achieved through medication therapy, procedural intervention, and rest. 3. Ambulation will increase demand for O₂ and is not recommended until the patient is stable. 4. The symptoms are caused by decreased oxygen or increased demand for oxygen in the myocardium. If the nurse increases the oxygen supply and decreases the level of activity (decreasing metabolic rates) to decrease the demands, ischemic tissue can recover or limit additional tissue death. 5. Preventing dysrhythmias prophylactically is not appropriate because the nurse may not know which type of irregularity will occur until it does occur. Early treatment should be used once the irregularity has been identified, but it is not recommended to give medications before symptoms have developed. Dysrhythmias occur due to hypoxia, electrolyte imbalance, necrosis, or fluid shifts in the myocardium once the vessel has ruptured or occluded in ACS.

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?

Accepted Answer

1. The formation of fibrin along the area of ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel.
2. When occlusion occurs, ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output.
3. Unstable angina occurs when a blockage from platelet-rich thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest.
4. The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size, and other vessels may compensate for this minor hypoxia until the vessel is completely occluded.

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.

Accepted Answer

1. Bleeding disorders increase the risk for stress ulcers in the postoperative period.
2. The age for increased risk is over 70 years old, not under 70.
3. History of alcohol abuse or excess increases the risk for stress ulcer formation in the patient recovering from this type of surgery.
4. The criteria for an increased risk are for those patients who have received a vasoconstrictor, not a vasodilator.
5. Prolonged use of cardiopulmonary bypass increases the risk for stress ulcer formation in the patient recovering from this type of surgery.

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?

Accepted Answer

1. Vitamin K is an antidote for warfarin. It increases hepatic biosynthesis of blood-clotting factors. But it is not a treatment for an active bleed.
2. This might take too much time and might be done later.
3. This might take too much time and might be done later.
4. The nurse should immediately 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?

Accepted Answer

1. Variant or Prinzmetal's angina occurs in an unpredictable pattern that is caused by vasospasm and causes transient ST-segment elevation. These are best treated with calcium channel blockers.
2. There is no such term used to describe angina.
3. Unstable angina does not respond well to nitroglycerin (NTG) and has no set pattern. The pain can occur at rest and with minimal exertion.
4. Stable angina occurs in a predictable manner, not when resting, and improves with NTG under the tongue.

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.

Accepted Answer

1. During surgery hypothermia results, and heating blankets, not cooling blankets, are used to stabilize core body temperatures.
2. This should be included in the teaching.
3. This should be included in the teaching for the patient and family.
4. This should be included in the teaching.
5. This should be included in the teaching.

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.

Accepted Answer

1. The pulse pressure will narrow, not widen, as fewer pressure differences are noted between the systolic and diastolic pressures.
2. As the heart is compressed within its own pericardial sac from fluid accumulation, the ability to expand is limited because fluid accumulates outside the heart to the point at which contraction cannot occur. The pressures back up and create increased pressure, as seen with engorging jugular veins.
3. The CVP increases, not decreases, as the backup occurs when the ventricles cannot pump and circulate the blood due to its limited motion.
4. As the heart is compressed within its own pericardial sac from fluid accumulation, the ability to expand is limited because fluid accumulates outside the heart to the point at which contraction cannot occur. The fluid surrounding the heart muffles the heart sounds.
5. Fluid ceases to drain from the pericardial tubes into the pleural (chest) tubes. As the heart is compressed within its own pericardial sac from fluid accumulation, the ability to expand is limited because fluid accumulates outside the heart to the point at which contraction cannot occur.

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?

Accepted Answer

1. The higher the hypertension rates, the greater the severity of ACS. There is a direct correlation between the two.
2. This statement does not indicate that more teaching is required.
3. This statement does not indicate that more teaching is required.
4. This statement does not indicate that more teaching is required.

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?

Accepted Answer

1. This is not a contraindication for the administration of this medication.
2. This is not a contraindication for the administration of this medication.
3. The purpose of this drug is to prevent platelet aggregation by keeping fibrinogen from binding to the GP IIb-IIIA receptors on the platelet surfaces. This condition is a contraindication for giving this drug group because increased bleeding episodes might follow its administration.
4. This is not a contraindication for the administration of this medication.

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?

Accepted Answer

1. This is not what the electrocardiogram tracing is indicating.
2. This is not what the electrocardiogram tracing is indicating.
3. This is not what the electrocardiogram tracing is indicating.
4. Early reperfusion can resolve coronary ischemia.

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?

Accepted Answer

1. NTG is used with stable angina, not Prinzmetal's angina.
2. Calcium channel blocking agents would be the drug of choice to stop the spasms of the coronary arteries that are causing the hypoxic pain in the myocardium from Prinzmetal's angina.
3. Lidocaine IV push will treat cardiac dysrhythmias but not hypoxic pain or coronary vasospasm.
4. Beta adrenergic blocking agents are used to treat stable angina.

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?

Accepted Answer

1. This is a symptom of cardiac disease and can occur in men and women, so it is not a differential for women.
2. Centralized chest pain is more likely to occur in men than in women.
3. Coronary symptoms in women include shortness of breath, fatigue, lethargy, indigestion, and anxiety.
4. Rales are evidence of fluid backup in the pulmonary system as seen in congestive heart failure. Both genders can have dyspnea and, therefore, it is not a differential factor.

Quiz 6: Care of the Patient Experiencing Shock