Question 1

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

Accepted Answer

Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.

Question 2

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

Accepted Answer

The patient is likely to be experiencing an ST-segment-elevation myocardial infarction (STEMI) and immediate therapy with PCI or fibrinolytic medications is indicated to minimize the amount of myocardial damage. The other ECG changes also suggest a need for therapy, but not as rapidly.

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?

Accepted Answer

The statement "It is important not to suddenly stop taking the atenolol" indicates that the patient understands the importance of gradually tapering off the medication to avoid rebound effects and potential harm. The other statements are incorrect or incomplete. Atenolol does not increase the strength of the heart muscle but rather reduces the workload on the heart by slowing down the heart rate and decreasing the force of contraction. Shortness of breath is not a common side effect of atenolol and may indicate an adverse reaction. While atenolol can improve blood flow to the coronary arteries by reducing heart rate and blood pressure, this is not the primary mechanism of action for preventing angina.

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

Accepted Answer

Visualization of the coronary arteries and possible balloon dilation are scheduled for this patient. Thrombolytic therapy is an alternative treatment if the patient is experiencing acute coronary syndrome (ACS) but is not the ordered therapy for this patient. Although angiography might help to detect structural defects or changes in cardiac output, it is not the reason for the procedure in this patient with symptoms of CAD.

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

Accepted Answer

Patients taking b-blockers should be monitored for bradycardia. Because this category of medication inhibits the sympathetic nervous system, restless, agitation, hypertension, and anxiety will not be side effects.

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?

Accepted Answer

A change in heart rate of more than 20 beats or more indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in oxygen saturation, are normal responses to exercise.

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

Accepted Answer

The goal of IV nitroglycerin administration in AMI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. Increases in heart rate and a drop in BP are common side effects of nitroglycerin. Nitroglycerin does not directly impact 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

Accepted Answer

The EMS system should be activated when chest pain or other symptoms are not completely relieved 5 minutes after taking nitroglycerin. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing. Gastric upset and dry mouth are not expected side effects of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis.

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?

Accepted Answer

The patient's chest pain may indicate that restenosis of the coronary artery is 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 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

Accepted Answer

All the nursing diagnoses may be appropriate for this patient, but the data indicate that the priority diagnosis is pain, a physiologic stressor. The patient's anxiety will also be reduced if the pain is resolved. There are no data indicating that the patient is experiencing cardiogenic shock or activity intolerance.

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

Accepted Answer

Prinzmetal's angina is caused by coronary artery spasm. Calcium-channel blockers (e.g., nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors, such as aspirin, help to prevent coronary artery thrombosis, and b-blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

Question 12

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

Accepted Answer

Because the medication is ordered to improve the patient's angina, so effectiveness is indicated if the patient is able to accomplish daily activities without chest pain. BP and apical pulse rate may decrease, but these data do not indicate that the goal of decreased angina has been met. The non-cardioselective b-blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in peripheral pulse quality or skin temperature.

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)?

Accepted Answer

Chest pain that lasts for 20 minutes or more is characteristic of AMI. Changes in pain that occur with raising the arms or with deep breathing are more typical of pericarditis or musculoskeletal pain. Stable angina is usually relieved when the patient takes nitroglycerin.

Question 14

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

Accepted Answer

Lifestyle changes are more likely to be successful when consideration is given to patient's preferences. The highest percentage of calories from fat should come from monosaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the patient with a list alone is not likely to be successful in making dietary changes. Removing saturated fat from the diet completely is not a realistic expectation; up to 7% of calories in the therapeutic lifestyle changes (TLC) diet can come from saturated fat. Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful.

Question 15

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

Accepted Answer

Chronic stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina.

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?

Accepted Answer

Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monosaturated fats such as are found in nuts, olive oil, and canola oil. The patient can include peanut butter sandwiches as part of the TLC diet. The other patient comments indicate a good understanding of the TLC diet.

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

Accepted Answer

Because family history, ethnicity, and age are nonmodifiable risk factors, the nurse should focus on the patient's activity level. An increase in activity will help reduce the patient's risk for developing CAD.

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?

Accepted Answer

Troponin levels increase about 3 hours after the onset of MI. The other laboratory data are useful in determining the patient's risk for developing CAD but are not helpful in determining whether an acute MI is in progress.

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?

Accepted Answer

Fibrinolytic therapy should be started within 6 hours of the onset of the MI, so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information will also be needed, but it will not be a factor in the decision about fibrinolytic therapy.

Question 20

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

Accepted Answer

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

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