Question 1

A few days after experiencing a myocardial infarction (MI)and successful percutaneous coronary intervention,the patient states,"It was just a little chest pain. As soon as I get out of here,I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?

Accepted Answer

When the patient is experiencing denial,the nurse should assist the patient in testing reality until the patient has progressed beyond this step of the emotional adjustment to MI. Asking the patient about vacation plans reinforces the patient's plan,which is not appropriate in the immediate post-MI period. Reminding the patient in denial about the MI is likely to make the patient angry and lead to distrust of the nursing staff.

Question 2

A patient who has recently started taking pravastatin (Pravachol)and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider?

Accepted Answer

Muscle aches and pains may indicate myopathy and rhabdomyolysis,which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin,and although the nurse should follow-up with the health care provider,they do not indicate that a change in medication is needed.

Question 3

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement,the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?

Accepted Answer

The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions,such as administration of oxygen and nitroglycerin,by the nurse. The other information indicates a need for ongoing assessments by the nurse.

Question 4

A patient admitted to the coronary care unit (CCU)with an ST-segment-elevation myocardial infarction (STEMI)is restless and anxious. The blood pressure is 86/40 mm Hg,and heart rate is 132 beats/min. Based on this information,which nursing diagnosis is a priority for the patient?

Accepted Answer

All the nursing diagnoses may be appropriate for this patient,but the hypotension and tachycardia indicate decreased cardiac output and shock from the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g.,brain,kidney,heart)and is a priority.

Question 5

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication?

Accepted Answer

The bile acid sequestrants interfere with the absorption of many other drugs and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. For maximum effect,colesevelam should be administered with meals.

Question 6

To improve the physical activity level for a mildly obese 71-yr-old patient,which action should the nurse plan to take?

Accepted Answer

Because patients are more likely to continue physical activities that they already enjoy,the nurse will plan to ask the patient about preferred activities. The goal for older adults is 30 minutes of moderate activity on most days. Older adults should plan for a longer warm-up period. Benefits of exercises,such as improved activity tolerance,should be emphasized rather than aiming for significant weight loss in older mildly obese adults.

Question 7

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care?

Accepted Answer

The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation. The other home medications should also be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.

Question 8

When caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization,which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

Administration of oral medications is within the scope of practice for LPNs/LVNs. The initial assessment of the patient,patient teaching,and titration of IV anticoagulant medications should be done by the registered nurse (RN).

Question 9

Which patient at the cardiovascular clinic requires the most immediate action by the nurse?

Accepted Answer

The history of more frequent chest pain suggests that the patient may have unstable angina,which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are stable.

Question 10

A patient who is recovering from an acute myocardial infarction (AMI)asks the nurse when sexual intercourse can be resumed. Which response by the nurse is best?

Accepted Answer

Sexual activity places about as much physical stress on the cardiovascular system as most moderate-energy activities such as climbing two flights of stairs. The other responses do not directly address the patient's question or may not be accurate for this patient.

Question 11

A patient who has chest pain is admitted to the emergency department (ED),and all of the following are ordered. Which one should the nurse arrange to be completed first?

Accepted Answer

The priority for the patient is to determine whether an acute myocardial infarction (AMI)is occurring so that the appropriate therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion,and an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours. Data from the chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction. Peripheral access will be needed but not before the ECG.

Question 12

Which electrocardiographic (ECG)change is most important for the nurse to report to the health care provider when caring for a patient with chest pain?

Accepted Answer

The patient is likely to be experiencing an ST-segment-elevation myocardial infarction. Immediate therapy with percutaneous coronary intervention or thrombolytic medication is indicated to minimize myocardial damage. The other ECG changes may also suggest a need for therapy but not as rapidly.

Question 13

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI)2 days previously. Which information is most important to report to the health care provider?

Accepted Answer

The crackles indicate that the patient may be developing heart failure,a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme inhibitors for the patient. Elevation in troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI.

Question 14

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI)to the intensive care unit,which action should the nurse perform first?

Accepted Answer

Because dysrhythmias are the most common complication of myocardial infarction (MI),the first action should be to place the patient on a heart monitor. The other actions are also important and should be accomplished as quickly as possible.

Question 15

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI)and percutaneous coronary intervention the previous day. Teaching for this patient would include

Accepted Answer

Early after an AMI,the patient will want to know when resumption of usual activities can be expected. At this time,the patient's anxiety level or denial will interfere with good understanding of complex information such as the pathophysiology of coronary artery disease. Teaching about discharge medications should be done closer to discharge. The nurse should support the patient by decreasing anxiety rather than discussing the typical emotional responses to myocardial infarction.

Question 16

After receiving change-of-shift report about the following four patients on the cardiac care unit,which patient should the nurse assess first?

Accepted Answer

After PCI,the patient is at risk for hemorrhage from the arterial access site. The nurse should assess the patient's blood pressure,pulses,and the access site immediately. The other patients should also be assessed as quickly as possible,but assessment of this patient has the highest priority.

Question 17

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI)3 days ago. Which nursing intervention included in the plan of care is appropriate for the registered nurse (RN)to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

LPN/LVN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient's response to exercise after a NSTEMI requires more education and should be done by the RN. Teaching and discharge planning and referral are skills that require RN education and scope of practice.

Question 18

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG)surgery using the internal mammary artery,the nurse determines that additional teaching is needed when the patient says which of the following?

Accepted Answer

When the internal mammary artery is used there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.

Question 19

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider?

Accepted Answer

The changes in the right hand indicate compromised blood flow,which requires immediate evaluation and actions such as prescribed calcium channel blockers or surgery. The other changes are expected or require nursing interventions.

Question 20

Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?

Accepted Answer

Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention may be needed. Bruising is a possible side effect of thrombolytic therapy,but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac biomarkers into the circulation as the blocked vessel is opened.

Quiz 33: Coronary Artery Disease and Acute Coronary Syndrome

A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention,the patient states,"It was just a little chest pain. As soon as I get out of here,I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider?

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement,the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg,and heart rate is 132 beats/min. Based on this information,which nursing diagnosis is a priority for the patient?

A patient with hyperlipidemia has a new order for colesevelam (Welchol) . Which nursing action is appropriate when scheduling this medication?

To improve the physical activity level for a mildly obese 71-yr-old patient,which action should the nurse plan to take?

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care?

When caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization,which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN) ?

Which patient at the cardiovascular clinic requires the most immediate action by the nurse?

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse when sexual intercourse can be resumed. Which response by the nurse is best?

A patient who has chest pain is admitted to the emergency department (ED) ,and all of the following are ordered. Which one should the nurse arrange to be completed first?

Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain?

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider?

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit,which action should the nurse perform first?

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching for this patient would include

After receiving change-of-shift report about the following four patients on the cardiac care unit,which patient should the nurse assess first?

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN) ?

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery,the nurse determines that additional teaching is needed when the patient says which of the following?

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider?

Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?